Abstract
Aim.  This study aimed to determine barriers to patient education from the perspective of patients, nurses and doctors.
Background. Patient education is one of the indicators of quality of heath care services. Patient education could lead to a reduction in the cost of health care and increase the quality of care and ultimately, help the patient to become independent and self-sufficient.
Method. A cross-sectional descriptive study was carried out. The research population included physicians, nurses and patients admitted to different wards of the Rajaee cardiovascular medical and research center. The sampling method was stratified random sampling for each population of the participants (patients, nurses and doctors). Data collection tool was a researcher-made questionnaire that measured the obstacles to patient education. The collected data were analyzed by SPSS software.
Findings. According to physicians, the most important barriers to education for patients was related to patients, and then related to physicians. From the viewpoint of nurses, the most important barriers to patient education were related to nurses. Patients evaluated themselves as the most important barrier to patient education, and then, the most important barriers were  related to nurses from patients’ perspectives.
Conclusion. Regarding the importance of teaching to the patient, it is suggested that the managers take actions to increase the number of nursing staff, provide patients with educational brochures, allocate sufficient funds for patient education, supervise and encourage nurses and doctors, and prioritize training in daily tasks.

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 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.

Abstract
Aim. This study aimed to compare the effect of spaced and mass education on stress and anxiety in candidates for angiography.
Background. Regarding the role of education in reducing stress and anxiety before angiography, comparison of the effect of spaced and mass education seems to be important in managing stress and anxiety in people experiencing this procedure.
Method. In this interventional study, statistical population consisted of candidates for angiography referred to selected hospitals of Isfahan in 2018. Sixty candidates for non-emergency angiography were selected by convenience sampling and were randomly divided into two groups of 30. The data collection instruments were the questionnaires demographic information, Cohen`s Perceived Stress (PSS14) and Spielberger`s Anxiety Inventory. Initially, all three questionnaires were completed by the participants. Then the education was provided by the researcher to the participants of the mass education group individually and face to face for 25 to 45 minutes (according to the participants tolerance) and in the end of the session, a 5 to 10 minutes time were given for answering participants’ questions. In the spaced education group, the educational content was provided by the researcher in three stages of 10 to 15 minutes and in groups of 3 to 6 participants. After the training of both groups, stress and anxiety were measured again by the questionnaires. Data were analyzed in SPSS version 16 using descriptive and inferential statistics.
Findings. Before and after intervention, there was no statistically significant difference between two groups in terms of mean scores of stress, state anxiety and trait anxiety. After intervention, a statistically significant decrease in mean scores of stress, state anxiety and trait anxiety were found in each group compared with before intervention.
Conclusion. Regarding the similar effect of spaced and mass education on stress and anxiety in candidates for angiography, it is recommended to use mass education method for candidates before angiography, since it is more cost effective and time saving than spaced education method.
 

Abstract
Aim. This study was conducted with the aim of determining the effect of peer education on outcome in people with heart failure.
Background. Heart failure is a complex clinical syndrome that is considered as a public health problem due to its chronic, progressive and irreversible nature.
Method. In this review study, a comprehensive search of scientific databases and search engines such as Science Direct, Scopus, PubMed, Google Scholar, and Medline using the keywords heart failure and peer education in both Persian and English language was done to find literature published between 2000 and 2018.
Findings. Studies about the effect of peer education on outcomes of heart failure patients in the country showed that these trainings have examined three outcomes of self-care, quality of life and self-efficacy in people with heart failure, and that this method has had a positive effect on all three components.
Conclusion. Peer education improves self-care, self-efficacy, and quality of life in people with heart failure. It is recommended to use this training program as an effective, cost-effective method without the need for specialized equipment.

Abstract
Aim. The present review study was conducted to investigate the effect of family-centered care education on outcomes of heart failure in Iranian patients.
Background. Heart failure is a complex clinical syndrome that poses a health problem due to its chronic, progressive, and irreversible nature.
Method. A comprehensive searching out scientific databases and search engines including Science Direct, Scopus, PubMed, Google Scholar, and Medline with the keywords heart failure and family-centered care education in both Persian and English language was done to find published studies between 2000 to 2020. Six articles were found based on inclusion criteria and reviewed to report their dominant findings.
Findings. Studies on the effect of family-centered care education on outcomes of heart failure in Iranian patients showed that this educational method has yield in effective results.
Conclusion. Family-centered care training improves and promotes self-care and quality of life in people with heart failure. Using this training program is recommended as an effective, cost-effective training method without the need for special equipment.

Abstract
Aim. This study aimed to examine the effects of preoperative preparation of patients and family caregivers on outcomes after coronary artery bypass graft surgery (CABG).
Background. Preoperative preparation can improve patients’ experience of surgery and hospitalization. However, there is limited data about how preoperative preparation affects postoperative outcomes following CABG.
Method. This non-randomized clinical trial was conducted on ninety pairs of patient/ caregiver in the time period from July to November 2018. The participants were purposively selected and non-randomly allocated to either control or experimental group. The intervention was performed one day after admission and the day before CABG in the form of an educational video, an intensive care unit tour, and an educational booklet. In both groups, on the third day after surgery, patients' delirium was assessed in the ICU and family caregivers were asked to complete a family satisfaction questionnaire. Patients and their family caregivers in both groups completed a hospital anxiety and depression questionnaire (HADS) on the first and seventh days after surgery and before discharge. Data were analyzed in SPSS version 16.0 using descriptive and inferential statistics. 
Findings. After intervention, the mean score of patients’ anxiety and depression in the intervention group was significantly less than the control group (P=0.03). After intervention, the mean score of anxiety and depression among family caregivers in the control and experimental groups were not significantly different (P=0.11). Family caregivers’ satisfaction of experimental group was significantly higher than the control group in both healthcare providers’ performance dimension (P=0.01) and comfort dimension (P=0.027). Moreover, the groups did not significantly differ from each other regarding delirium incidence (P=0.6) and length of stay in the intensive care unit (P=0.21).
Conclusion. Considering that the preparation of the patient and family caregiver on the day before CABG can reduce patients' anxiety and depression and increase the satisfaction of the family caregiver, it is recommended to use this intervention for patients and family caregivers before CABG.

Abstract
Aim. This study was conducted to assess family follow-up for children with implantable defibrillators and the role of nurse in patient/ family education
Background. Implantable defibrillators are devices with the capability of rhythm detection and anti-arrhythmia therapy. The proper functioning of these devices highly depends on regular interrogation, analysis, and programming.
Method. This descriptive comparative study was conducted based on the hospital information system (HIS) of Rajaie Cardiovascular Medical and Research Center. All children under 15 years of age, for whom the defibrillator device had been implanted or followed by the first author, from 2009 to 2020, were included. Continuation of follow-up was compared according to age, gender, underlying disease, area of residence, and type of family education. Data were analyzed in SPSS-24 using descriptive and inferential statistics. 
Findings. Sixty-seven implantations had been done for 61 patients. The mean and standard deviation of patients’ age was 9.58±3.72 years (aged 1 to 15 years). The rate of follow-up continuation was significantly reduced during the follow-up period. Ninety-four percent of patients had been visited for the first post-implantation appointment; this rate decreased to 43.6 percent for the 5th year post-implantation visit (p≤0.0001). Follow-up continuation was 71.13 percent with old-type family education compared to 89.64 percent with the new-type one (p=0.002).
Conclusion. Considering the high-risk situation, follow-up continuing is less than those desired for children with defibrillator devices. Family education by interactive methods plays an important role in encouraging the families to regular follow-up.

Abstract
Aim. The present study was performed to examine the effect of virtual reality therapy training on Covid-19 anxiety in patients with hypertension in Corona pandemic.
Background. In addition to numerous physical problems, Covid-19 has had many psychological consequences such as stress and anxiety, especially in the community of chronic patients, including patients with hypertension. Therefore, appropriate interventions to reduce Covid-19 anxiety in patients with hypertension are essential.
Method. The present study was a quasi-experimental with a pretest-posttest design and a control group. The statistical population of the study consisted of all patients with hypertension referred to Ardakan Heart Clinic, Yazd, Iran. Using the available sampling method and according to the inclusion and exclusion criteria, 60 people were selected and randomly allocated to experimental (n=30) and control (n=30) group. Both groups completed the Alipour’s et al. (1398) Covid-19 questionnaire in the pre-test and post-test stages. The experimental group received the training in 6 sessions of one hour duration. Then, both groups completed the research questionnaires again in the post-test stage. Data were analyzed in SPSS version 26 using descriptive and inferential statistics.
Findings. After intervention, there was a statistically significant difference between the experimental and control group in terms of the mean scores of Covid-19 anxiety (P≤0.0001, F=110.807), psychological dimension of Covid-19 anxiety (P≤0.0001, F=78.30), and the physical dimension of Covid-19 anxiety (P≤0.0001, F=94.27).
Conclusion. Implementing virtual education intervention program with the content of reality therapy can reduce anxiety and its psychological and physical dimensions in people with hypertension.

Abstract
Aim. The aim of this study was to compare the effect of acceptance and commitment-based therapy and emotion regulation education on chronic pain and self-care in women with coronary artery disease.
Background. Research shows that coronary heart disease is one of the leading causes of death and disability in the world, which reduces the useful efficiency of people. Psychological factors can change many aspects of patients' lives and relationships.
Method. The research design was quasi-experimental pre-test-post-test with control group. The statistical population in this study included all women with coronary artery disease referred to Tabriz Heart Hospital in 2020. Women who had inclusion criteria were selected and randomly assigned to the first experimental group (n=15), the second experimental group (n=15) and the control group (n=15). The first experimental group (emotion regulation education) was subjected to 12 sessions of 90-minute duration (three sessions per week), The second experimental group (acceptance and commitment-based therapy) received 8 sessions of 90-minute duration, and the control group did not receive any intervention. The chronic pain scale of Von Korff et al. and the self-care scale of Rigel et al. were used to collect the data. Data were analyzed by multivariate analysis of covariance and LSD post hoc test in SPSS Version 21.
Findings. The results showed that treatment based on acceptance and commitment and emotion regulation education have an effect on chronic pain and self-care of patients with coronary artery occlusion (P ≤0.0001), as they reduced chronic pain and improve patients' self-care. The results also showed that acceptance and commitment therapy has a greater effect on chronic pain and patients' self-care than emotion regulation education.
Conclusion. Attention to acceptance and commitment therapy and emotion regulation education can play a role in reducing the psychological problems of women with coronary artery disease.

Abstract
Aim. The aim of the study was to examine the effect of lifestyle education using a mobile phone application on adherence to the treatment regimen in patients with hypertension.
Background. High blood pressure is the most important risk factor for cardiovascular diseases and mortality. Educational applications have provided an effective method for self-care and blood pressure control of patients.
Method. This research is a clinical trial study. The number of samples in control and experimental group was 60 people. In the experimental group, the training was conducted using the mobile application at least three times a week for two months and was followed up during the course through phone calls and virtual networks. In the control group, the usual training of the health center was provided. The degree of adherence to the treatment plan of the patients was measured by a researcher-made questionnaire, before and two weeks after the end of the intervention. Data analysis was done in SPSS version 21 using t-test, multivariate covariance analysis and post-hoc test.
Findings. Comparing the adherence to the treatment program between the two groups after the educational intervention, the mean and standard deviation of the scores of the control and experimental group was 337±22 and 441±20, respectively. There was a statistically significant difference between groups after the intervention in all variables including blood pressure, diet, physical activity, drug regimen, and other domains of compliance with the treatment program (p≤0.0001), which indicated the effectiveness of lifestyle training using a mobile phone application on blood pressure and adherence to the treatment plan.
Conclusion. The use of mobile phone application can be effective and useful for improving and controlling blood pressure among patients with hypertension. Nurses, as one of the most important members of the health care team, can have a direct impact on patients’ quality of life through educational interventions