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Aim

Background

The purpose of this study was to measure the effect of endotracheal suctioning in-service education on the patients’ blood oxygen saturation and heart rate changes in intensive care unit.One of the basic steps in caring and maintaining the airway is endotracheal suctioning. If this procedure is not performed with proper technique, it will be associated with many complications.

Method

This study is an outcomes research performed in medical intensive care unit of Hazrate-Rasool Hospital in 2010. All nurses working in intensive care unit and all performed endotracheal suctioning cases in a period of two weeks before and after in-service education were selected as research sample.

Findings

Conclusion

Therefore, it is necessary to provide in-service education programs in relation to nurses' attention to the hemodynamic changes and to minimize these changes, and thereby to protect life and safety in critically ill patients.

The results showed mean arterial oxygen saturation decreased significantly (p =0.005) in the first and third minutes post-suctioning before conducting in-service education. Besides, the results showed the mean arterial oxygen saturation increased significantly (p≤0.001) in the first and third minutes post-suctioning after conducting in-service education. Also, mean heart rate increased significantly (p≤0.001) in the first and third minutes post-suctioning before conducting in-service education. The mean heart rate increased significantly (p≤0.001) in the first minute post-suctioning after conducting in-service education, but in third minute post-suctioning this difference was not significant.The research findings show significant changes in blood oxygen saturation and heart rate post-endotracheal suctioning. These changes are an important complication in critically ill patients and can be life-threatening particularly.

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Aim

The aim of this study was to compare the quality of life amongst asthmatic boys and girls aged between 7-17 in Zanjan 

Background

The quality of life in patients with chronic disorders is highly affected by the diseases, especially when such variables as gender and age interfere with the situation. Youngsters suffering from asthma face numerous physical, social and psychological problems.

Method

In a descriptive-comparative study, 290 asthmatic children aged between 7-17 "minimum after six month of the disease were selected by consecutive sampling method. Demographic information form and Asthma Quality of Life Questionnaire (AQLQ) were completed by parents. The data were analyzed by SPSS software using T test, Mann- Whitney U and analysis of variance.

Findings

The study findings showed the mean score quality of life was (50.56, SD=19.45) for girls and (36.02, SD=16.49) for boys. Statistical analysis showed a significant difference between the quality of life amongst asthmatic boys and girls (p=0.012).

Conclusion

The difference between the quality of life in asthmatic boys and girls should be considered when planning programs to enhance their quality of life. Thus, it is proposed the quality of life to be tested in both genders, in different ages with different chronic diseases.

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Aim. The aim of this study was to determine the family members’ performance in confront with

patient's heart attack and its relationship with their knowledge in this filed.

Background. Heart attack is one of the most common, serious and fatal diseases. It is growing

rapidly worldwide and is the most leading cause of mortality. The performance of people who

deal with the heart attack patients in the early minutes, is important in prognosis of disease and

his/her life and death .

Method. This correlational descriptive study was conducted on 300 family members of

patients with heart attacks who hospitalized in teaching hospitals of Iran University of Medical

Sciences. Data were collected by a questionnaire and continuous sampling. Validity of

questionnaire was confirmed by content validity and its reliability were confirmed by test-retest

and by internal consistency ( 0.92).

Findings. The findings showed that there was good level of knowledge, but poor performance

of the subjects in confront with patient's heart attack. There was statisticaly significant

correlations between performance and the knowledge (p=0.004), but no significant correlations

between performance and the knowledge with level of education, age and gender.

Conclusion. Despite of good level of knowledge in target community, none of them have good

performance in the confront with heart attack patients therefore it is recommended to educate

the public on how to deal with heart attack patients and to perform more studies in this field

in order to offer appropriate strategies to promote the knowledge and performance of family

members and individuals in society.

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Aim. The aim of this study was to determine the effect of first phase cardiac rehabilitation

programs on anxiety and depression in acute coronary syndrome (ACS) patients.

Background. Anxiety and depression are psychological factors influencing the prognosis,

recovery, and adherence to treatment in patients with ACS. Cardiac rehabilitation programs are

an important part of the care plan is arranged for the majority of heart patients.

Method. This clinical trial study was conducted on 88 ACS patients with regard to the inclusion

criteria. The subjects were randomly divided to experimental (n=44) and control (n=44) groups.

The experimental group participated in four educational sessions of cardiac rehabilitation

program, which included familiarity with risk factors of heart disease, nutrition and drugs

recommendations, stress and depression reduction methods and exercises training. Information

booklet was given at the end of the sessions. Data were collected by demographic and diseaserelated

questionnaires and Persian version of Hospital Anxiety Depression Score (HADS).The

data were analyzed by SPSS software version 16.0 and descriptive and analytic statistical tests

(Independent t-test and Chi-square and Fisher's exact test).

Finding. The findings showed that there was no statistically significant relationship of

demographic and disease-related information with anxiety and depression scores before study.

There was significant statistical difference between two groups in the mean of anxiety and

depression score after intervention (P_0.0001).

Conclusion. According to the finding, the first phase cardiac rehabilitation programs is effective

in reducing anxiety and depression in ACS patients Therefore, it can be an effective way to plan

nursing care of patients with ACS.

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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.

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Abstract

Aim. The aim of this study was to examine the effect of foot reflexology massage on incisional pain in thoraco-abdominal surgery patients admitted to surgery intensive care unit.

Background. Although the most commonly used method of pain relief is pharmacologic, the medications prescribed excessively for severe and chronic pain in patients have side effects and non-pharmacological methods of pain relief may be useful.

Method. In this quasi-experimental study, 102 patients within the age range of 25 to 50 years without any other surgical complication, and normal feet which have undergone thoraco-abdomical surgery were enrolled. They were randomly allocated into 3 equal groups: massage group, pseudo-massage group and control group. The pain was measured Visual Analogue Scale (VAS) before, right after, 10 minute and 24 hours after the treatment. Other data was extracted from medical records. The information was analyzed by SPSS using appropriate statistical tests.

Findings. According to the findings, there were no statistically significant difference between the groups in terms of age sex marital status educational levels underlying diseases and type, duration and severity of the surgery. The pain score was not significantly different between groups before and right after the intervention. However, 10 minutes and 24 hours after the intervention, pain score was lower in the massage group. The use of pharmacological analgesics had also reduced in the massage group.

Conclusion. Foot reflexology was effective on incisional pain after thoraco-abdominal surgery. Nurses can use this intervention to improve patient comfort and decrease  pain medications administration in thease patients.

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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.

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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 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 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.

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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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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.

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Aim. This study aimed to examine the effect of local thermotherapy on pain severity in patients with chronic peripheral arterial occlusive disorders. Background. Chronic peripheral arterial occlusive disorders are among the most commonly and disturbing diseases which mainly affect the lower extremities. Chronic peripheral arterial occlusive disorders are the most common causes of disability. Many of patients with chronic peripheral arterial occlusive disorder suffer from pain. Methods. In this randomized clinical trial, 60 patients with chronic peripheral arterial occlusive disorders, referred to specialized unit of Mashhad Imam Reza Hospital, were recruited through convenience sampling and randomly allocated to control (n=30) and intervention group (n=30). A questionnaire including information about demographic characteristics and disease status were completed for all patients. Then, the pain severity of patients was measured before the intervention.  In the experimental group, the damaged limb of patients (from below of knee to fingers) put in the hot water (41 ° C) for 20 minutes. After thermotherapy, the pain severity of patients in the experimental group was measured again. Intervention was implemented for 5 consecutive days. The patients in control group received only routine medical treatment in the ward during 5 days and each day, their pain severity were measured. Data were analyzed by using SPSS 14 and descriptive and inferential statistics. Findings. The mean pain severity of patients after the intervention showed a statistically significant decrease (P<0.0001). The mean pain severity of patients in control group during 5 days showed no statistically significant difference. Conclusion Thermotherapy with hot water significantly decreases pain severity of patients with chronic peripheral arterial occlusive disorders.

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Aim. The purpose of this study was to examine the effect of acupressure on anxiety in patients under mechanical ventilation. Background. Mechanical ventilation is a frequently used technological modality for patients in Intensive Care Unit (ICU), and this treatment has potential to produce a variety of unpleasant stress and physiological and psychological complications. Anxiety is one of the most common mental reactions in patients under mechanical ventilation. Acupressure as a non-pharmacological approach may improve anxiety in these patients without side effects. Method. This was a randomized block experimental study in which 164 ventilated patients with stable hemodynamics and GCS≥9 who had study criteria were randomly allocated into experimental or control group. Patients in the experimental group received two sessions/day of acupressure along with routine care for two consecutive days, but patients in the control group received only routine care. The anxiety was measured with Faces Anxiety Scale (FAS), before, right after, and one hour following every acupressure session. The data were analyzed by SPSS software using descriptive and inferential statistics. Findings. Baseline anxiety level was high in most of patients. Anxiety in the experimental group decreased significantly (p=0.032) when compared with control group, over time. Anxiety was significantly different between groups, right after intervention in every session of acupressure (p<0.0001). In the experimental group, time-dependent changes of anxiety was statistically significant (p<0.0001) and anxiety was significantly different before and right after intervention in every session of acupressure (p<0.0001). The amount of change in anxiety was not significantly different between sessions. Conclusion. Acupressure therapy could reduce anxiety significantly in patients with mechanical ventilation. Critical care nurses can use this non-pharmacological approach to reduce anxiety in patients under mechanical ventilation.

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Aim. This paper reviews various types of inducing hypothermia and related nursing care after cardiopulmonary arrest. Background. The patient experiencing post-resuscitation syndrome after cardiopulmonary arrest, requires admission in critical care unit to receive intensive care and constant monitoring. Method. Electronic databases was searched out to find related articles published within the last 5 year about hypothermia therapy and cardiopulmonary arrest. Some textbooks was also read to prepare this paper. Findings. Cooling techniques can be divided to noninvasive and invasive methods. Ice packs application to the groin, torso, axillae, and neck is an example of noninvasive cooling technique. Invasive cooling techniques include cold infusion, Intravascular cooling, and venovenous technique. Conclusion. Hypothermia therapy can be recommended as an effective method to reduce complications following cardiopulmonary arrest.

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Aim. This study was conducted to examine the effect of acupressure on severity of pain and fatigue in patients with chronic heart failure. Background. Patients with chronic heart failure experience high levels of pain and fatigue. Acupressure is a simple, inexpensive and non-invasive method which may reduce the pain and fatigue in patients with chronic heart failure. Method. In this single blind randomized clinical trial, 72 patients with chronic heart failure were recruited. Subjects were equally divided into two groups of experimental and placebo, by random allocation method. Then visual analogue scale and fatigue severity scale was used to evaluate the severity of pain and fatigue in each group. The members of experimental group were under acupressure in KI3 , GV20 and CV6 point for 3 minutes bilaterally. In addition, the participants were instructed to perform acupressure in same point three times a day for four weeks. Subjects in placebo group were trained to touch the points. Four weeks after intervention, the severity of pain and fatigue was measured in both groups. The data were analyzed by SPSS. Findings. The study findings showed no statistically significant difference between the groups in terms of demographics, and severity of pain (p=1.000) and severity of fatigue (p=0.285) before intervention. After four weeks of intervention, a statistically significant relief on severity of pain (p=0.006) and fatigue (p≤ 0.0001) was seen in experimental group compared with placebo group . Conclusion. Acupressure can be effective in decreasing severity of pain and fatigue in people with chronic heart failure.

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Aim. This study was conducted to determine the effect of instrumental music on sleep in patients admitted to the coronary care unit (CCU). Background. Poor quality sleep, as a distressing situation, can aggravate myocardial ischemia and infarction. The music as a cheap, and noninvasive approach with a slow rhythm, monotonous and repetitive, may have inducing-sleep or relaxation effect. Method. The present study was a clinical trial conducted in 2014. The samples consisted of 72 patients with acute coronary syndrome admitted to coronary care unit of hospitals affiliated with Tehran University of Medical Sciences. They were selected using the simple random sampling method and divided into experimental (n=36) and control (n=36) group. The quality of sleep was measured in the beginning of hospitalization and three days after admision, and the quantity of sleep was measured all the three days using the Pittsburgh sleep quality index and the sleep log quantity indices in experimental and control group. The intervention was implemented in the form of playing instrumental music in headphones since the first night of hospitalization for a three-night time span (45 minutes a night) in the beginning of the patients’ sleep. Data were analyzed by SPSS software, version 16, using descriptive and inferential statistics (chi-square, fisher's exact test, independent samples T test). Findings. According to the findings, the mean change in the sleep quality score, before and after intervention, and sleep quantity at the three nights of hospitalization were significantly different between experimental and control group (p<0.0001). Conclusion. The instrumental music can be effective in improving patients’ sleep quality and quantity. Therefore, nurses can benefit from this non-pharmacological method in their daily care to improve their patients’ sleep.

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Aim. The aim of this study was to evaluate the current and expected status of comfort from the point of view of hospitalized cardiac surgery patients. Background. Providing comfort for the patient is one of the most important aspects of nursing that should be considered in all aspects of care as the top nursing care priority. Method. This was a descriptive comparative cross-sectional study in which 292 patients undergoing cardiac surgery were recruited as study sample. Data collection tool was a demographic form and modified form of Kolcaba's comfort questionnaire evaluating the current and expected status of comfort. After that the reliability and validity of the questionnaire was confirmed, it was completed by interview, the second day after surgery. Data analysis was performed by SPSS, version 16. Findings. The participants reported the best current status of comfort in psychospiritual (63.57 percent) and sociocultural (62.71 percent) domains of comfort, and rated physical domain of comfort as the lowest one(36.64 percent). Patients reported the comfort status in the environmental domain as moderate (54.78 percent). The most expectation of the patients were to be provided with comfort in psychospiritual (92.02 percent), environmental (91.14 percent) and physical (90.96 percent) domains, respectively, and the provision of comfort in sociocultural domain were least expected (88.16 percent). There was a statistically significant relationship of comfort with gender, age, education, occupation, place of residence, income, number of family members, physical activity and history of heart surgery, hypertension and hyperlipidemia. Conclusion. Patients reported less comfort in the physical domain and the most expected domain of comfort was psycho-spiritual. It is recommended that nurses pay more attention to providing comfort in physical and psychospiritual domains.