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Abstract

Aim.This study aimed to compare pulse pressure variation (PPV) with central venous pressure (CVP) in checking out and optimizing fluid volume in mechanically ventilated patients admitted to intensive care unit after cardiac surgery.

Background.In clinical area, assessment of body fluid and determination of the intravascular volume  after major surgeries such as heart surgery is a significant challenge. The initial purpose of intravascular volume assessment in patients with hemodynamic instability is to determine whether they would benefit from fluid administration or not.

Method. In the present study a prospective descriptive-analytic design was used. Thirty mechanically ventilated patients admitted to intensive care units of Rajaee Heart Center, Tehran, Iran, were recruited in the study after cardiac surgery based on inclusion criteria. Data collection tools included demographic and clinical data sheets. Hemodynamic parameters such as CVP, systolic and diastolic pressures (for calculating pulse pressure and its variation) were recorded by bedside monitoring. Cardiac Index (CI) was measured by non invasive continuous cardiac output monitoring (NICCOMO) system. Data were analyzed in SPSS version 20, using statistical tests.

Findings. The mean changes of CVP, before and five minutes after fluid administration, were significantly different (10.10±6.01 mmHg and 12.37±6.34 mmHg, respectively, p=0.015). The mean changes in arterial pulse pressure, before and five minutes after fluid administration, were significantly different (16.94±8.32 mmHg and 12.77±4.02 mmHg, respectively, P=0.005). At the cut point 2.8 lit/min/m2 for CI, the sensitivity and specificity values for PPV>13%, were 0.71 and 0.61, respectively. Also, at the same cut point, the sensitivity and specificity values for CVP<5mmHg, were 0.11 and 0.84, respectively. These findings suggest a higher diagnostic power  of  PPV compared to CVP to assess fluid volume.

Conclusion.It seems that in the mechanically ventilated patients after heart surgery, PPV dynamic index is preferred to CVP static index to evaluate and maintain fluid volume.

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Abstract
Background. Self-care behaviors in cardiac patients are one of the essential factors in their treatments. The failure to apply proper self-care behaviors reduces their recovery and imposes high costs on the health care system.
Aim. This study aimed for design and psychometric measurement of the questionnaire on attitude, knowledge and utilization of self-care for patients undergoing coronary artery bypass graft surgery based on Waltz model
Method. In this methodological study, the following four steps were conducted for design and psychometric measurement of the questionnaire: 1) defining the theoretical and practical self-care concept for patients undergoing coronary artery bypass graft surgery in the domains of physical activity, sexual activity, social activity, mental state, and smoking; 2) designing the items of the questionnaire using other instruments which are being used in heart diseases; 3) determining the face validity (the assessment of facility, difficulty, and ambiguity of the items and their importance for patients) and content validity of the questionnaire (the assessment of appropriateness and necessity of items by experts opinions and measuring CVR and CVI; 4) the internal consistency of the questionnaire was evaluated by determining the Cranach's alpha coefficient.
Findings. The first version of this questionnaire was produced with 56 items, of which 15 items were deleted during the process of validity and reliability confirmation. The final version of the questionnaire was provided with 41 items in three domains; knowledge domain with 14 items, attitude domain with 7 items and utilization domain with 20 items. The results of the psychometric procedure for the questionnaire was the content validity index of 0.99, the content validity ratio of 0.96 and the internal consistency of the questionnaire with Cronbach's alpha coefficient of 0.7 representing appropriate validity and reliability of the questionnaire.
Conclusion. This 41-item questionnaire can be utilized in the assessment process of these patients. Measuring construct validity is recommended for the validity of the domains of the present questionnaire.

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Abstract
Aim. The purpose of this study was to determine the relationship between compassion fatigue and moral sensitivity in nurses of critical care units of hospitals affiliated to Qazvin University of Medical Sciences. 
Background. Nurses encounter conditions during taking care for clients that can lead to a type of fatigue called compassion fatigue. Ethical sensitivity as the basis of ethics in nursing can be helpful in reducing nursing care problems.
Method. This study was a cross-sectional descriptive-correlational study in which 200 nurses working in critical care units of hospitals affiliated to Qazvin University of Medical Sciences were recruited in the study through census sampling method and inclusion criteria. Demographic characteristic form, and the compassion fatigue questionnaire and moral sensitivity questionnaire was used for data collection. Data were analyzed in SPSS version 19 using descriptive and inferential statistics.
Findings. The mean score of moral sensitivity was 53.21±13.69 and the mean score of compassion fatigue was 25.55±4.66. Spearman correlation coefficients revealed that there was a statistically significant and reverse correlation between moral sensitivity and compassion fatigue among critical care nurses (r=0.171, p=0.015).
Conclusion. The moral sensitivity of critical care nurses is related to their compassion fatigue. Therefore, provision of a framework for strengthening the moral sensitivity of nurses could be effective in reducing this phenomenon.

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