Abstract
Aim.This study was conducted to investigate the level of nurses’ knowledge, attitude and practice about self-care education in people with heart failure.
Background.Heart failure is one of the most common chronic diseases and the leading cause of death in the world and also, a major cause of hospital readmission, especiallyin elderly patients. Self-care education is an essential componentof care for people with heart failure. Nurses are the first providers ofself-careeducation for patients and must have a thorough knowledge, a positive attitude and skillfull practice in the field of self-care education.
Method. In this descriptive-analytical study, 174 nurses with at least one year working experience in the CCU, post CCU and medical wards of ShahidRajaie Cardiovascular and Research Center, completed a four-part questionnaire including demographics information, and knowledge, attitude and practice about self-care education in people with heart failure. Data were analyzed using descriptive and inferential statistics in SPSS, version 22.
Findings. The majority of nurses (70.1 percent)  had an average knowledge score. The knowledge level of nurses were significantly related with level of education and working experience. Also, 67.8 percent of the participants had a good practice of self-care education about heart failure and their practice was significantly related with experiencing in-service education. More than 90 percent of nurses reported positive attitude towards self-care education about heart failure and their attitude was significantly related with level of education, in-service education and work schedule.
Conclusion. The knowledge of nurses was at average level. It is recommended to plan in-service education in order to promote nurses’ level of knowledge about self-care education about heart failure.

Abstract
Aim. This research aims to investigate the effects of spiritual care on pain in patients undergoing coronary artery bypass grafting (CABG) surgery.
Background. Pain as a significant problem in patients undergoing CABG requires nursing care. Because of side effects from opioids, it is important to use non-pharmacological approaches such as spiritual care to control pain in these patients.
Method. This clinical trial was performed on 70 patients after CABG. Data collection tools included a demographic questionnaire, and McGill Pain questionnaire. The patients were randomly assigned into two groups of experimental and control. Spiritual care program in the experimental group included supportive presence, supporting patient’s rituals, and using supportive systems for 3 days. Pain levels were measured before and after intervention for both groups. The control group did not receive any intervention. Data were analyzed in SPSS version 20.
Findings. There was no statistically significant difference between the two groups in terms of in demographic characteristics. Before intervention, no statistically significant difference was found between the pain scores of the groups, however, after the intervention, pain scores were significantly lower in the experimental group than in the control group. There was also a statistically significant difference between the pain scores of the experiment group before and after the intervention. Such a difference was not found in the control group.
Conclusion. Spiritual care program reduced pain in patients undergoing CABG. With regard to the results of the present study, it is suggested that nurses include religious-spiritual care in nursing care plan as a helpful way to control pain in these patients.

Abstract
Aim. This study aimed to examine the effect of participation-based education program on nurses' knowledge and practice of critical care nurses about central venous catheter care in intensive care units in teaching hospitals of Zanjan University of Medical Sciences, Iran.
Background. Improving the quality care of central venous catheters requires the promotion of nurses’ knowledge of standard guidelines and manuals of catheter care and also the knowledge of latest findings in this field.
Method. In this quasi-experimental study with pretest-posttest design, 46 nurses working in intense care unit of two teaching hospitals (Ayatollah Mousavi and Vali-e-Asr hospital) were recruited into experimental group (n=28) and control group (n=18). Before intervention, nurses' knowledge and performance regarding central venous catheter care were measured by the questionnaire developed by Labio et al. in 2008 and a researcher-made observational checklist. Then, educational intervention based on participation was implemented for the experimental group for 1 month, and routine intervention (taking part in one session lecture) was also carried out for the control group. Three months after intervention, nurses' knowledge and performance were measured again through questionnaire and checklist by the co-researcher. Data were analyzed by SPSS (version 16) utilizing Chi-square, Fisher, ANOVA, and independent t-test and paired-sample t- test.
Findings. After intervention, there was a statistically significant difference between experimental and control group in mean change of knowledge score (experimental group, 2.82 against control group, 1.67)(p=0.004) and performance score (experimental group, 11.69 against control group, 10.85) (p≤0.0001) about central venous catheter care.
Conclusion. Educational intervention based on participation is more effective than the other conventional retraining programs in improving the nurses' knowledge and performance about central venous catheter care. It is suggested to apply participation-based education program for in-service training.

Abstract         
Aim. This study aimed to determine the relationship between self-care behaviors and readmission in people with heart failure.
Background. People with heart failure are frequently hospitalized due to worsening symptoms. Admission to hospital reduces quality of life of patients, also imposes large costs for them. To control this disease, adherence to self-care behaviors is important.
Method. In this descriptive analytical study, 245 heart failure patients with the history of readmission were recruited with convenience sampling method from Taleghani and Syedalshohada teaching hospitals of Urmia, in 2016. Data collection tool included self-care heart failure Index. Data were analyzed by descriptive and inferential statistics using SPSS.
Findings. Self-care mean score in participants was 45.59±7.6 and most patients had a moderate level of self-care behaviors. Pearson correlation coefficient showed a reverse statistically significant correlation between self-care score with the number of hospitalization (r=-223, p≤0.0001).
Conclusion. Self-care behaviors of the majority of patients was not favorable in terms of quality and there was a reverse correlation between self-care behaviors and readmission, It is suggested further investigating the factors affecting self-care behaviors and taking actions to deal with these factors.

Abstract
Aim. This study aimed to evaluate the perceptions of nurses working in intensive care units about obstacles and supportive behaviors of end of life care.
Background. End of life care is an important part of nursing duties in intensive care units. Exploring supportive behaviors of end of life care from the perspective of nurses may lead to better understanding of supportive behaviors and obstacles of end of life care.
Method. This study was a descriptive cross-sectional study in which 160 staff nurses, working in intensive care units in Rajaei Cardiovascular Medical and Research Center, were recruited by random sampling in 2016. Data were collected using demographic form and the questionnaire “National Survey of Critical-Care Nurses Regarding End-of-Life Care” (NSCCNR-EOL) and analyzed in SPSS version 22 software using descriptive statistics.
Findings. The most important obstacle in end-of-life care was "family and friends who continually call the nurse wanting an update on the patient's". In the field of supportive care, "After the patient's death, having support staff compile all the necessary paper work for you" received the highest score.
Conclusion. Based on the findings, in critical care nurses views, appropriate training on end-of-life care and palliative care for staff, educating families about issues of death and dying, and the holistic care of patients and their families improve end-of-life care of dying patients.

Abstract
Aim. The purpose of this study was to review the nursing care and education of patients with Ventricular Assist Device (VAD).
Background. Heart failure is one of the most important noncommunicable diseases. There are many pharmacological and non-pharmacological approaches for treatment of heart failure. These treatments have contributed to the survival of people with this disease. Nursing care of patients with VADs can prolongs patient’s quality of life and survival. 
Method. This review study was conducted in 2018 using the keywords heart failure, intraventricular assist devise, cardiovascular disease, survival rate, complications of heart failure and nursing care, by searching in the search engines/ databases Google Scholar, OVID, Up-to-date, Springer, PubMed, SID, MagIran, Web of Sciences, Cochrane Library, CINHAL, and Scopus without time limit. A total of 63 articles were found related to the subject under study, out of which, 10 duplicate articles were omitted from the list and 4 articles were excluded because they were not available; this way, 49 papers were included in the study.
Findings. The role of the nurse in teaching patients with VADs is very important. Patient education can be a help for improving quality of life and increasing patient’s survival.
Conclusion. Familiarity with the new approaches to manage heart failure is very important for nurses. VADs have complications such as infection, bleeding, and arrhythmias; recognition, prevention and management of these complications can improve patient’s quality of life and survival.

Abstract
Aim. This study aimed to compare physicians’ and nurses' perceptions of futile care.
Background. Futile medical care is the provision of medical care or treatment to a patient when there is no reasonable hope or chance of a benefit. Determination of perceptions of futility is crucial to reduction of situations leading to futility and end-of-life decision-makings.
Method. The present study is a descriptive-comparative cross-sectional study in which 114 nurses and 57 physicians working in intensive care units of selective teaching hospitals of Shiraz University of Medical Sciences were recruited by convenience sampling method based on the inclusion criteria. The data collection instrument was a researcher-made questionnaire of futile care perception whose validity and reliability was assessed by experts, test-retest and Cronbach's Alpha methods. The Data were analyzed using descriptive and analytical statistics in SPSS software version 16.
Findings. The mean score of physicians’ and nurses’ perceptions of futile care was 77.29±13.79. The mean score of nurses’ perception was 78.46±14.4, turned out to be higher than that of physicians (74.91±12.3). The highest level of consistency between the two groups was related to the item "ineffective communication" and “disregarding the members in the decision-making process by the ICU attending physician”. As for "stressfulness of futile medical care", nurses experienced higher stress levels and there was a statistically significant difference between the two groups in this regard.
Conclusion. The agreement on the most important factors affecting the perception of futility indicates consistency between physicians’ and nurses’ perceptions of futile care. The high perception scores in both groups, and the stressful nature of futile medical care require necessary training mechanisms needed to deal with such situations.

Abstract
Aim. The purpose of this study was to compare the effect of clinically-indicated replacement and routine replacement of peripheral venous catheters on catheter-related complications and satisfaction in patients undergoing cardiac surgery.
Background. The insertion of peripheral vein catheter is one of the most commonly used minimally invasive measures in hospitalized patients. Catheters can be maintained until they are working well.
Methods. A randomized controlled clinical trial was conducted in intensive care units of Rajaie Cardiovascular Medical and Research Center in 2017. After ethical Approval, 104 Patients were randomly allocated to either clinically-indicated replacement or routine replacement of peripheral venous catheters (every 96 hours) (52 Patients in each group). Data collection tools included demographic form, catheter placement data sheet and a researcher-made patients’ satisfaction questionnaire. Data were analyzed in SPSS using descriptive and inferential statistics.
Findings. There were no statistically significant difference in terms of the incidence of complications between the groups. Also, there were no statistically significant difference between the scores of satisfaction of the patients of the control and experimental group.
Conclusion. No evidence was found of superiority of routine replacement of peripheral venous catheters over clinically-indicated replacement. Caregivers may consider changing the protocol of catheter replacement from routine replacement to clinically-indicated replacement. This would protects patients from the unnecessary pain of routine replacement in the absence of clinical indications.

Abstract
Aim. The purpose of this study was to determine the effect of teaching health-promoting behaviors on self-care behaviors in people with hypertension.
Background. Hypertension is one of the chronic diseases that causes serious complications on the organs of the body and requires self-care behaviors to be managed and controlled. Education increases self-care capacity in these patients and may help reducing complications and promote disease control.
Method. In this quasi-experimental study, 106 patients who referred to the clinic of Shahid Rahimi Hospital in Khorramabad, affiliated to Lorestan University of Medical Sciences, were recruited based on inclusion criteria and allocated to experimental (n=53) and control group (n=53). The experimental group received three training sessions of health-promoting behaviors in three consecutive weeks. The control group received only the routine treatments. Data were collected using a demographic form and self-care behaviors questionnaire, before and one month after intervention. Data were analyzed by SPSS version 22 using descriptive and inferential statistics.
Findings. The groups did not differ significantly in terms of demographic variables and disease characteristics. Before intervention, the mean score of self-care in the control and experimental group were 8.33±1.79 and 9.7 ±2.41, respectively, and there was a statistically significant difference between the groups (P=0.002). After intervention, the mean score of self-care in the control and experimental group were respectively reported as 8.43±1.84 and 14.46±2.13. Analysis of covariance showed that after intervention, the mean score of self-care in experimental group was significantly higher than that of control group (P≤0.0001).
Conclusion. Education improved self-care in people with hypertension. Providing education for people with hypertension can be effective in promoting their self-care behaviors.

Abstract
Aim. The purpose of this study was to determine the effect of supportive interventions on resiliency components and quality of life among family caregivers of people with advanced heart failure.
Background. Advanced heart failure is a costly, progressive and chronic disease that reduces resilience and quality of life among family caregivers.
Method. In a randomized clinical trial study that was conducted as a before-after design with control group and follow-up one month after intervention. One hundred family caregivers of people with advanced heart failure, admitted to Shahid Rajaie Cardiovascular and Medical Research Center, were randomly assigned into experimental and control group. The family support interventions package included participation in group training workshops for 6 sessions (2 sessions/week in three consecutive weeks) for the experimental group. Resilience Scale (Connor-Davidson) and Quality of Life (SF-36) questionnaire were used to collect the data, before, after and one month after intervention. Data were analyzed in statistical software SPSS 23 using statistical tests related to the distribution of variables including Chi-square, Fisher, Wilcoxon and Mann-Whitney test, and independent and paired t-test.
Findings. At baseline, the mean score of resilience and the overall score of quality of life showed no statistically significant difference between the groups. After intervention, there was a statistically significant difference in terms of the mean score of resilience between the experimental (64.06±11) and control (48.34±16.23) group (P<0.05). Also, the overall score of quality of life after intervention was statistically significant between the experimental (70±12.91) and control (50.82±17.73) group (P<0.05). The results of paired t-test showed that one month after the end of the intervention, in the experimental group, the mean score of resilience (63.08 ± 10.15) and the overall score of quality of life (69.82±12.70) remained constant, indicating the sustainability of the effect of interventions after one month (P>0.05).
Conclusion. As part of a holistic program, the results of this study can be a guide to setting up a centralized unit for the education and support of family caregivers of people with chronic heart disease, a unit in which, in addition to social support and mental health education, their needs in terms of knowledge of the disease and participation in the care of their patients would be met.

Abstract
Aim. This study aimed to investigate the effect of clinical follow-up by a nurse on improving self-care behaviors in people with heart failure.
Background. People with heart failure are frequently hospitalized. One of the main reasons for hospitalization of these patients is the individual's inability to perform self-care behaviors. One of the ways that can help to improve self-care is clinical follow-up of these patients by nurses.
Method. This study was a randomized clinical trial which was conducted between October 2015 to May 2016 in Cardiovascular Medical and Research Center in Tehran. Eighty patients were recruited from the patients hospitalized in cardiac intensive care units and randomly assigned to control and experimental groups. Patients in experimental group received clinical follow-up by a nurse every two weeks by phone or in person. The control group received routine follow-up after discharge. Self-care behaviors were assessed by the checklist before intervention and three month after intervention. The data were analyzed in SPSS using descriptive and inferential statistics.
Findings. The mean score of self-care behaviors, before intervention was 2.64±1.62 in control group and 2.02±1.62 in the experimental group, and there was no statistically significant difference between groups. After intervention, the mean score of self-care behaviors in control and experimental group were 2.38±2.50 and 0.93±7.82, respectively and a statistically significant difference was found between the groups (p≤0.0001).
Conclusion: Clinical follow-up by a nurse can improves self-care behaviors in people with heart failure and help to lessen the burden.

Abstract
Aim. The present study was conducted to compare the effect of e-learning and lecture education on critical care nurses' performance about cardiovascular medication.
Background. The present time is known as the technology development time, and the educational institutions have undergone major changes. The complex learning process should not be limited to classroom and the use of  e-learning can help to overcome some barriers of traditional methods of education in nursing.
Method. This quasi-experimental study was conducted on 70 nurses working in intensive care units of social security hospitals in Isfahan province in 2017. They were recruited to the study and allocated randomly   to either lecture (n=35) or e-learning (n=35) group. Nurses’ performance was evaluated by the questionnaire of cardiovascular medication before and after the interventions, and the effect of two methods of e-learning and lecture training on nurses’ performance scores was compared.
Findings. Both lecture and e-learning methods had a statistically significant effect on nurses' medication performance (P≤0.0001). However, no statistical significant difference was observed between the two groups in terms of changes in nurses' medication performance.
Conclusion. E-learning can be a substitute for lecture education in-service-training of pharmacology topics for critical care nurses.

Abstract
Aim. This study was conducted to evaluate effect of bedside teaching on critical care nurses' performance in airway suctioning
Background. One of the most effective measures in patients undergoing mechanical ventilation is suctioning the trachea to prevent the accumulation of potentially infectious pulmonary secretions and to clear the airway which is carried out by critical care nurses. If suctioning cannot be correctly performed, some complications may occur.
Method. This was a quasi-experimental study in which the study sample consisted of 54 critical care nurses working in Rajaie Cardiovascular Medical and Research Center, Tehran, Iran. The nurses were recruited through convenience sampling based on inclusion criteria. Critical care nurses’ performance in airway suctioning were evaluated before and two weeks after intervention using a checklist. The intervention included bedside teaching of suction procedure.
Findings. Two weeks after intervention, the mean score of performance in airway suctioning increased significantly (P≤0.0001). Hand washing or using hand was recorded only for 16 nurses before intervention and for 35 nurses after intervention. Maintaining catheter sterility during suctioning was considered by 28 nurses before intervention, and by 40 nurses after intervention. Correct procedure documentation and recording secretion characteristics before and after intervention were carried out by 13 and 34 nurses, respectively. While activating suction during bringing the catheter out of endotracheal tube was done by 31 nurses before intervention, after intervention 41 nurses did so.
Conclusion. Bedside teaching of correct airway suctioning for critical care nurses enhance their performance in this procedure.

Abstract
Aim. The purpose of this study was to review the patient– and family-centered care studies in coronary artery bypass graft surgery.
Background. Nowadays, the length of hospital stay after cardiac surgery is reduced, and the most of the patients recover at home with their families without usual nursing and medical care. It is necessary to provide the care based on the same needs.
Methods. This is a comprehensive review of literature published between 1990-2018 about patient- and family-centered care interventions and patient/family important outcomes in adult ICUs that was conducted through searching out databases and search engines Medline, Ovid, Science Direct, PubMed and Google scholar, including English and Persian papers. In total, 73 English papers and 46 Persian papers were found, out of which 25 papers were included in this review.
Findings. Engaging families in patient care can profoundly influence clinical decision making and patient outcomes. Yet in many hospitals and health care systems, outdated visiting policies separate families and other loved ones during hospital stays.
Conclusion. Patient– and family-centered care is associated with better clinical outcomes. The clinical benefits that have been identified through a family partnership approach in these settings include decreased mortality, increased satisfaction, improved adherence to treatment regimens, and decreased readmission rates. Although high-quality interventional studies are needed to further evaluate the effectiveness of patient- and family-centered care in coronary artery bypass surgery, it is obvious this movement in healthcare is making a huge impact on family satisfaction and patient outcomes.

Abstract
Aim. The purpose of this study was to examine the effect of peer education on the anxiety - of post Coronary Artery Bypass Graft patients and caregivers
Background. Patients undergoing coronary artery bypass surgery experience moderate to high anxiety, which has also been reported among their family members. Studies have shown that educating patients and their family caregivers has in many cases reduced their anxiety. Peer education and research on the effect of peers is of great importance in promoting therapeutic and caring goals.
Method. This randomized clinical trial study was performed in year 2018 in surgery wards of Rajaee Cardiovascular Medical and Research center. In this study, 60 family caregivers of patients undergoing coronary artery bypass graft surgery and their respective patients were recruited at the time of discharge from intensive care unit and entering into the surgical ward. The subjects were randomly assigned to experimental and control group. Data collection tools included demographic information questionnaire and Spielberger's "State and trait anxiety" form. Initially, patients' family caregivers who were selected as peers were trained by the researcher in three stages. Before visiting the patients by family caregivers, their anxiety and also, patients' anxiety was measured in both groups. Thereafter, the patients’ family caregivers in the control group received routine training, and the patients' family caregivers in the experimental group received peer training in two sessions by their peers. In the third step, the anxiety of patients and their family caregivers in both groups were measured on the second and fifth days after intervention. The data were analyzed in SPSS 20 software.
Findings. Before intervention, the mean scores of anxiety in the experimental and control groups were not statistically different in both patients and their family caregivers, and the mean anxiety scores in both groups were moderate to high. After intervention, the mean score of anxiety in the experimental group was significantly lower than the control group (P≤0.0001). Also, in the second and fifth days after the intervention, there was a significant difference between the experimental and control groups in the mean score of anxiety of the patients and their family caregivers (P≤0.0001).
Conclusion. Peer education seems to reduce anxiety in patients and their family caregivers after discharge from ICU. It is suggested that peer education be used as effective and low cost education to reduce patient and family caregiver anxiety.