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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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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 aim of this study was to examine the effect of preferred music on sleep quality of patients after coronary artery bypass surgery (CABG). Background. Sleep disorder is common among patients undergoing coronary artery bypass surgery that can also affect other postoperative outcomes. Method. This study was a quasi-experimental trial in which 70 patients who were undergoing coronary artery bypass surgery were recruited using convenience sampling method and assigned into the experimental and control group. Patients in experimental group listened to their preferred music by MP3 player for 20 minutes during 4 consecutive days, while patients in control group received only routine care. The patients’ sleep quality was measured before and after the intervention by means of Pittsburgh sleep quality inventory. Data were analyzed by SPSS, version 16, and descriptive and inferential statistical were used to report the findings. Findings. There was no statistically significant difference in sleep quality, before and after intervention in experimental and control groups. Conclusion. Music did not have effect on sleep quality among patients undergoing coronary artery bypass surgery, but the study can be reproduced with some modifications (change in intervention time and period and targeted selection of patients) in future studies.

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Aim. The aim of this study was to examine the role of liaison nurse on vital signs of patients in the process of transition from cardiac surgery intensive care unit to general ward. Background. Patients' transfer from intensive care unit to a general ward is accompanied by anxiety, stress and changes in patients' vital signs. It is said that the role of liaison nurse solve the problems between intensive care unit and the general ward and prevent adverse events during transfer of patients. Method. This was a quasi-experimental study in which 68 patients were recruited and allocated to experimental and control group. In both control and experimental group, demographic and disease characteristics were collected in the beginning of the study .The experimental group received liaison nurse services during transfer process. Vital signs of the patients were measured and recorded at the beginning of transfer and two hours after admission of patient in the general ward. The data were analyzed by SPSS version 19 and using statistical tests. Findings. Before intervention, the experimental and control group were homogeneous in terms of demographics and vital signs except for systolic blood pressure. After intervention, significant reductions were found in vital signs in the experimental group. Conclusion. Liaison nurse services affect the vital signs of patients in the process of transition from cardiac surgery intensive care unit to general ward.

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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 articles and clinical trial evidence regarding diet for cardiovascular disease (CVD) prevention. Background. CVD is rapidly becoming a primary cause of death worldwide. Thus, identification of dietary changes that most effectively prevent CVD is necessary. Method. This review was conducted by searching out electronic databases and hand searching of library resources. Searching out articles and research projects was conducted by using keywords on the internet and relevant sites. Findings. According to the findings, at least 3 dietary strategies are effective in preventing CVD: substituting non-hydrogenated unsaturated fats for saturated and trans-fats increasing consumption of omega-3 fatty acids from fish, fish oil supplements, or plant sources and consuming a diet high in fruits, vegetables, nuts, and whole grains and low in refined grain products. Conclusion. According to the current evidence, diets using non-hydrogenated unsaturated fats as the main form of dietary fat, whole grains as the main form of carbohydrates, an abundance of fruits and vegetables, and adequate omega-3 fatty acids can offer significant protection against CVD. Such diets, along with regular physical activity, avoidance of smoking, and maintenance of ideal body weight may prevent the majority of cardiovascular disease.

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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. The aim of this study was to investigate the effect of the eight-week concurrent training on quality of life in patients with myocardial infarction. Background. Myocardial infarction is a major cause of mortality around the world. Myocardial infarction affects patient's quality of life significantly, and it is important to find modalities to reduce harmful effects of the disease. Method. A randomized clinical trial was conducted. Thirty patients referred to Taleghani hospital, located in Tehran, Iran were recruited and randomly assigned to either experimental (n=15) or control group (n=15). Patients in experimental group trained three times a week for eight weeks in cardiac rehabilitation department of Taleghani hospital. Quality of life was evaluated before and after training by SF-36 questionnaire. In order to analyze the data, SPSS version 18 was used. Findings. The results showed that when compared with control group, the quality of life in experimental group has increased significantly. Conclusion. According to the findings, it seems that eight weeks of concurrent training can improve quality of life in patients with myocardial infarction.

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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.

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

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

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

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

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

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Heart failure is one of the major causes of mortality in developed countries. Usually before heart failure, remodeling occurs to adapt to myocardial wall stress changes or pressure caused by external stimuli. Cardiac remodeling encompass many of the changes associated with the development of heart failure, like genome expression changes, and cellular, molecular and interstitial changes, that causes a change in size, shape and function of the heart after damage. Cardiac remodeling shows the capacity of heart to response and adaptation to a variety of stimuli. The ultimate goal of cardiac remodeling is adaptation to and properly reducing the increased wall stress, and maintaining or even increasing cardiac function. In general, cardiac remodeling is divided into two categories: physiological and pathological, each have different causes and consequences.

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Aim. This study was conducted to assess physical activity in elderly people with heart disease, in Ilam, Iran.

Background. Regarding the increasing number of elderly people, paying attention to their health is of great importance. Regular physical activity is being regarded as a way of reinforcing the immune system and preventing non-communicable diseases.

Method. A descriptive cross-sectional study was conducted on 240 elderly patients admitted to post CCU and CCU of hospitals in Ilam, Iran. The sample was recruited by convenience sampling method. The questionnaire “Rapid Assessment of Physical Activity” (RAPA) was used to assess physical activity. SPSS version 17 was used to analyze the data through descriptive statistics (mean and standard deviation) and inferential statistics.

Findings. Of 240 elderly people participated in the study, 108 were male and 122 were female. Only 5% of the subjects had appropriate physical activity according to the World Health Organization classification. Physical activity was found to be statistically related with age, education, income, occupation, and marital status.

Conclusion. Physical activity was at a low level among older adults. It is necessary to take interventions for improving physical activity in elderly people. It is suggested to teach them appropriate life style in terms of physical activity.

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Aim. The aim of this study was to determine the effect of patient education and  nurse-led  telephone follow-up (telenursing) on adherence to treatment in patients with acute coronary syndrome admitted to cardiac care units hospitals affiliated to Alborz University of  Medical Sciences.

Background. Increasing adherence to treatment is essential in patients with acute coronary syndrome to reduce readmissions and improve the recovery, but only patient education does not guarantee the adherence to treatment and it is necessary to follow-up patients after discharge.

Method. This randomized clinical trial study was conducted on patients with acute coronary syndrome admitted to the selected hospitals of Karaj, Iran, in 2014. In this study, 90 patients were selected purposively and randomly allocated  in  three groups of education (n=30), education/ telephone follow-up (n=30), and control (n=30). Data collection instrument was questionnaire. Data were gathered at baseline and 12 weeks after the intervention. Patients in educational groups  (education, and education/ telephone follow-up groups) were trained before discharge using educational pamphlets. Telephone follow-up were implemented for education/ telephone follow-up group for 3 months; twice a week in the first six weeks and weekly in the second six weeks. The data was analyzed by descriptive and inferential statistics in SPSS version16.

Results. After intervention, there was a statistically significant difference between the groups in terms of adherence to treatment (P=0.001). Participants in the education/ telephone follow-up group and education group experienced more improvement in adherence to treatment than the control group.

Conclusion. Both patient education and education/ telephone follow-up have effect on improvement of adherence to treatment, but education/ telephone follow-up results in more improvement in adherence in comparison to education. It is recommended to implement education/ telephone follow-up for patients with acute coronary syndrome.

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Aim. This study was conducted to examine the effect of nursing ethics workshop on patients rights practiced by nurses in the emergency department.

Background. According to the goals of 20 years vision and development plans of Iran, moving toward improving the quality and safety of patients and their rights are of the main priorities of health care system approved by national and international experts and authorities.

Method. This study is quasi-experimental study with control group. To measure dependent variable (patient’s right practice by nurses), before and after intervention, perspectives of 180 patients admitted to emergency department were selected by convenience sampling. Intervention was implemented for emergency department nurses. All emergency department staff nurses working in a governmental hospital in the City Shahriar, Iran, were selected. The data were collected through a questionnaire composed of 2 parts, demographic information and 15 questions designed based on patients rights protocol in 5 domains with Likert scale. In order to ensure reliability, Cronbach’s Alpha was calculated for internal consistency coefficient through interviews with 20 patients (&alpha;=0.84). Validity of the questionnaire was evaluated by 10 experts. The questionnaire were completed before and one month after intervention through interviewing with patients admitted to the emergency department during the data collection time period. Data were analyzed by SPSS version 22.

Findings. Before intervention, the mean score of patient’s right practice was 58.83±16.81 and after intervention, the mean score of patient’s right practice increased to 84±8.12. There was a statistically significant difference between the mean total score of patient’s rights practice based on patients perspectives, before and after intervention (p˂0.0001). The lowest score for patient’s rights practice was reported for the domain information giving (15%) and the highest score was reported for the domain respect for privacy (82.7%).

Conclusions. The intervention (nursing ethics workshop) has a positive effect on patient’s rights practice by nurses in the emergency department.

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Aim. The present study aims to determine the relationship between family performance indices (cohesion, expressiveness, and conflict) and the risk of myocardial infraction.

Background. Cardiovascular diseases, especially myocardial infraction, is the first factor of fatality in the world and also in Iran. The etiology of myocardial infraction is a very complicated. One of the risk factors overlooked in the studies associated with the etiology of cardiovascular disorders is family and performance indices of the family.

Method. The present research was conducted by a case-control cross-sectional design. The data were collected from two groups, a group of 50 patients with myocardial infraction symptoms (case group) referring to Heshmat Specialized Hospital for Cardiology in Rasht and Tehran Specialized Heart Center, and a group of 50 healthy persons (control group) with no symptoms of myocardial infraction. The data gathering tool included Family Relationships Index. The data were analyzed by SPSS version 16 using MANOVA method.

Findings. There was a statistically significant difference between case and control groups in terms of control variables: history of myocardial infarction, education, history of smoking, history of cholesterol and hypertension (p<0.01), and history of diabetes (p<0.05). There was also a statistically significant difference between groups in terms of cohesion, and conflict indices (p<0.01).

Conclusion. Deficiency in family performance indices, including cohesion, and conflict in family relationships, are among the main risk factors of myocardial infarction. Therefore, it is necessary to prepare and implement social, behavioral and educational interventions in order to prevent negative effects of inadequacies in family performance indices.

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Aim. The aim of this review was to determine the clinical outcomes of blood transfusion in patients undergoing coronary artery bypass graft surgery. Background. Despite efforts to reduce the use of blood products in cardiac surgeries, its use is still high. Blood should be considered as a scarce source which can lead to some clinical outcomes. Method. In this paper, a review was conducted on the studies published between 2002-2015. The studies were searched out through scientific databases, including PubMed and Science Direct by the keywords blood transfusion, adverse effects, clinical outcomes, coronary artery bypass graft surgery and their Persian equivalents. Findings. The review of 15 studies revealed that survival rate 30 days and 1 year among patients received blood transfusion were significantly less than patients without blood transfusion. Mortality (short and long term) in patients with blood transfusion was significantly higher than patients without blood transfusion. Also, patients receiving blood transfusion had more complications including atrial fibrillation, infection, pneumonia and cerebral vascular accident as compared with patients without blood transfusion. Conclusion. Blood Transfusion increases mortality, hospital stay and several various complications. It is essential that policy of limited blood transfusion to be considered against free blood transfusion.

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Aim. This study was conducted to examine the effect of deep and slow breathing on pain and pain outcomes during arterial sheath removal after undergoing coronary angioplasty.

Background. During the last 30 years, coronary angioplasty has been the most common method for management of coronary artery stenosis. Lack of control or treatment of the pain caused by arterial sheath removal may have some consequences, most notably increased heart rate and blood pressure in patients.

Method. This is a clinical trial study conducted on 60 patients undergoing coronary angioplasty, hospitalized between April and August 2015 in the catheterization laboratory of Shariati hospital, Tehran, Iran. Patients were divided into two groups using random number table. The intervention was slow, deep breathing techniques by inhale and exhale ratio of 4 to 6. Data were analyzed using SPSS.

Findings. Immediately and 5 minutes after sheath removal, the average pain score in the intervention group  was significantly lower rather than control group (P<0.05). There was no statistically significant difference between groups in terms of blood pressure and heart rate average. The average number of vasovagal attack was significantly different between the groups. The average number of vascular complications was not significantly different between intervention and control group.

Conclusion. The use of slow and deep breathing and relaxation technique is effective on pain management and the incidence of vasovagal attacks after arterial sheath removal, and can be used as an easy and safe method to decrease patients’ discontent caused by pain.

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Aim. The aim of this study was to evaluate the ethical sensitivity and its relationship with demographic characteristics in critical care nurses of Shahid Rajaee Heart Center in Tehran.

Background. Nurses are the largest group of service providers in the health care system, and must be aware of and sensitive to ethical issues related to their profession. Ethical sensitivity is the basis of ethics in nursing enabling nurses to take care of their patients effectively and ethically.

Method. In this descriptive-analytical study, 181 nurses working in the intensive care units of Shahid Rajaee Heart Center hospital were randomly selected. Data were collected through demographic questionnaire and standard questionnaire of the nurses’ moral sensitivity. Moral sensitivity has six aspects: respecting the patient independence, awareness of how to communicate with patients, professional knowledge, experiencing the ethical problems, using moral concepts in decision-making ethics, integrity and benevolence. The data were analyzed based on SPSS version 19, using descriptive and inferential statistics.

Findings. The mean score of nurses’ ethical sensitivity was 70.85±7.73 with the highest scores in the domain knowledge of how to communicate with patients and the lowest score was related to the domain the level of professional knowledge. Among the demographic variables, there was a statistically significant correlation of age, average weekly work hours, and years of working with ethically sensitive nurses; with the increase of age and experience, the moral sensitivity was also increased, while the ethical sensitivity decreased as a result of the increase of average weekly work hours.

Conclusion. Considering that moral sensitivity in this study was moderate, it is recommended that nurse managers standardize the weekly working hours of the nurses in intensive care units in order to increase the ethical sensitivity in nurses.