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Aim

The aim of this study was to evaluate the effect of planned breathing exercises on oxygenation in patients undergoing coronary artery bypass surgery.

Background

Pulmonary complications and impaired oxygenation are common after coronary artery bypass graft surgery and cause increased hospitalization and health care costs. Breathing exercises are applied commonly in managing coronary artery bypass graft (CABG) patients in many hospitals, but scientific evidence is not sufficient about the efficacy of this treatment.

Method

In a clinical trial , 100 patients undergoing CABG were randomly allocated to planned breathing exercises (n=50) and control group (n=50). The patients in experimental group received breathing exercises protocol (deep breathing, incentive spirometry and directed cough maneuvers) and the patients in control group received daily routine hospital physiotherapy. Other therapies were similar in two groups. Arterial blood gases were compared between groups before operation and the first, second and third postoperative day. The data were analyzed by SPSS Version 17 software using chi square, T test and analysis of variance.

Findings

The study findings showed no statistically significant difference between groups in terms of demographic data, history of chronic diseases, Pao2 and Sao2 before surgery and on the first and second day after surgery. On the third postoperative day, the mean score of SaO2 (95, SD=2.47 vs. 93.24, SD=16.3, p=0.003) and PaO2 (83.19, SD=16.23 vs. 72.66, SD=13.20, P≤0.001) were higher in the experimental group.

Conclusion

The patients receiving planned breathing exercises including deep-breathing exercises, incentive spirometry and directed cough maneuvers have better oxygenation after coronary artery bypass surgery.

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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 to examine the effect of massage therapy on sleep quality of patients after coronary artery bypass surgery (CABG).

Background. Poor sleep quality is common among patients following CABG and has been noticeable for more than 30 years.

Method. In this quasi-experimental study, 72 patients, who had undergone CABG in Isfahan Chamran Hospital were were recruited. The patients were randomly assigned to the two experimental and control groups. The patients of the experimental group received light pressure stroking massage for 20 minutes in four sessions after the surgery. The patients in control group received only the routine care. The patients› sleep quality was measured before and after the intervention with St Mary›s Hospital Sleep Questionnaire. Data were analyzed by SPSS software, version 18 and descriptive and inferential statistical methods were used for data analysis.

Findings. Mean scores for sleep quality before the intervention in the experimental and control groups were 22.5±3.6 and 22±3.8, respectively, and no statistically significant difference seen between them. After the intervention, there was a statistically significant difference between mean scores for sleep quality of the experimental and control groups (11.8±2.8 vs 15.5±4.7) (P<0.001).

Conclusion. The use of massage therapy can promote sleep quality of patients after CABG and due to low cost and simplicity it can be used as a complement to drug therapy and postoperative interventions implemented in these patients.

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Abstract

Aim. This study was conducted with the aim of evaluating the effect of spritual care based on «GHALBE SALIM» model on spritual experiences of the patients who have undergone coronaryartery bypass surgery.

Background. Patients undergoing open heart surgery, experience a crisis in their life. Every crisis is considered as a spiritual crisis and creates a unique experience that is rooted in culture and religion. Spiritual intervention which considers the spiritual mutual experience of the therapist and client is called spiritual care based on «GHALBE SALIM» model.

Method. In this clinical trial, 60 patients, candidated for elective coronary artery bypass graft surgery, were randomly assigned to experimental and control groups. Experimental group received spiritual care based on»GHALBE SALIM» model during hospital stay. The questionnaire Daily Spiritual Experience Scale (DSES) was completed by patients at the time of admission and discharge.

Findings. The level of spritual experiences at the time of hospitalization was not statristically significant between groups. On discharge, after implementing «GHALBE SALIM» model, the level of spritual experiences in experimental group was significantly higher in comparison with control group (P<0.001).

Conclusion. Spiritual care based on «GHALB SALIM» model increases the level of spiritual experiences and could be performed for meeting spiritual needs of patients.

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Abstract

Aim. This study was conducted to examine the effect of supportive nursing program on depression, anxiety and stress of family members of patients during coronary artery bypass graft surgery.

Background. patient’s family members experience high levels of depression, anxiety and stress during coronary artery bypass graft surgery. Informational and emotional support of family members during surgery may have significant effect on reducing their psychological distress and enabling them to better support of the patient.

Method. This semi-experimental study was conducted on 104 relatives of patients. They were recruited in the study with regard to the inclusion criteria and assigned to either experimental (n=52) or control (n=52) group. The experimental group received supportive nursing program including informational and emotional support. The control group only received routine interventions. Data were collected by demographic form and modified Depression Anxiety and Stress Scale (DASS). The data were analyzed by Chi-squire and T-test using SPSS software, version 21.   

Findings. There were no statistically significant differences between control and intervention group regarding the mean scores of depression, anxiety and stress before surgery. After intervention (at the end of surgery) experimental group reported significantly lower levels of depression, anxiety and stress (P<0.0001).

Conclusion. According to the finding, supportive nursing program could reduce depression, anxiety and stress of family members of patients during coronary artery bypass graft surgery so, we suggest this program as an effective intervention to support family members during coronary artery bypass graft surgery.

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Abstract

Aim.The purpose of this study was to examine the effect of patient education on postoperative pain perception in patient undergoing Coronary Artery Bypass Graft (CABG).

Background.Pain is a common complication after CABG surgery. Non-pharmacological methods are more favorable than pharmacological agents. 

Method.In this quasi-experimental study, 72 patients who were scheduled for elective CABG surgery  were randomized to experimental (n=36) and control group (n=36). Experimental group received educational intervention about pain control, one day before surgery (20-30 minutes duration), while control group received no intervention. Following transferring to the ICU and 2 hours after extubation, patients’ pain intensity wasmeasured by Johnson’s numerical scale. The measurements wererepeated twice withanintervalof threehours. The type and dosage of pain medication administered during ICU stay were recorded. To analyse the data, descriptive(mean and standard deviation, frequency distribution and percentage) and analytical statistics (Chi-square and Mann-Whitneytest) were used.

Findings.There was no statistically significant difference between two groups in terms of demographic characteristics. Two hours after extubation, there were no statistically significant difference between experimental and control group in the intensity of pain (P=0.313). Pain intensity was significantly lower in experimental group than control group, 5 hours (P=0.015) and 8 hours (P=0.006) after surgery. The results also showedthat the amount ofanalgesics used to relieve post-operativepain was significantly lower in experimental group than control group (P=0.046).

Conclusion.Patient education about pain control may have positive effects on postoperative pain in patients undergoing CABG surgery. This intervention could serve as an effective strategy for nurses to improve pain management among these patients. 

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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 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 aimed to evaluate the effect of preoperative cardiac surgery nursing care education on anx-iety, quality of sleep, fasting time and cardiac medication usage in cardiac surgery patients.

Background. Cardiac surgery is one of the most important therapeutic approaches in patients with heart diseases. According to previous studies it is necessary to reduce the anxiety level and improve the quality of sleep the night before surgery, fasting according to standard protocols and continuing usage of cardiac medications.

Method. This study was a quasi-experimental trial in which patients were studied in two groups (before-training group and after-training group). One hundred cardiac surgery patients were selected based on in-clusion criteria as before-training group and evaluated in terms of anxiety level, quality of sleep, fasting time and cardiac medication usage in the night before surgery. Sampling lasted for 42 days. Then, all of the surgical nurses were trained individually for a week, and given pamphlets. Their educational content in-cluded the latest fasting protocols, non-pharmacological methods of reducing anxiety and improving quality of sleep and emphasizing on the importance of cardiac medication usage in the night before surgery. Then, another 100 patients were evaluated as the after-training group. Sampling from this group lasted for 38 days. The tools included demographic sheet and Spielberger anxiety questionnaire. Data were analyzed with SPSS software.

Findings. The findings of this study showed a statistically significant difference in anxiety level between before-training group and after-training group (P<0.0001). Also, there was a significant statistical differ-ence in quality of sleep between two groups (P=0.004). But, there was not a statistically significant differ-ence in fasting hours and cardiac medication usage between two groups.

Conclusion. According to the findings, educating preoperative cardiac surgery nursing care decreased anxi-ety level and improved quality of sleep in after-training group. But this intervention neither decreased fast-ing hours nor increased continuing cardiac medication usage in after-training group.

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Aim. The aim of this study was to evaluate the effect of using “Pain Assessment Tool” by nurses on analgesics requirement and patient’s satisfaction after coronary bypass graft surgery.

Background. One of the main duties of caregivers in ICU is relieving patients’ pain. Using "Pain Assessment Tool" may have a positive effect on the choice of analgesics and dosage adjustment with patients’ requirements. More research is still needed.

Method. In a clinical trial, 153 hospitalized patients in the intensive care unit were selected randomly and were divided into two experimental (n=77) and Control group (n=76). The Pain Assessment Tool and pain management for 48 hours were implemented for conscious patients. Routine measures were taken into account for control group and the severity of pain and analgesic injection for experimental group were determined. In both groups, the amount of analgesics administered for pain relief, and patient satisfaction were recorded. Data were analyzed by SPSS version 16.

Findings. The use of Pain Assessment Tool increased the number of recipients of analgesic drugs and reduced their dosage over 48 hours in the experimental group. Also, the satisfaction of pain relief was higher in the experimental group than the control group (p<0.0001).

Conclusion. The findings of this study demonstrate the positive effect of Pain Assessment Tool on pain control, proper use of analgesics, prescribing the proper dose of analgesics based on patients’ pain and satisfaction improvement. The measurement of pain severity using Pain Assessment Tool, before and after analgesics administration is suggested.

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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. The aim of this study was to evaluate the effect of early mobility on respiratory parameters in patients after open heart surgery. Background. Post-operative phase of open heart surgery is the most critical period during which many serious and fatal complication can occur. Early mobility can prevent such complications. The role of the critical care nurse is crucial in this regard. Method. In a randomized clinical trial, 104 patients who were candidate for open heart surgery were randomly assigned to experimental (n=52) and control (n=52) group. Patients in control group received hospital routine treatments. Patients in experimental group were mobilized from the bed in the first, second and third day after surgery. Early mobility included change position, siting on the bed, legs dangling off the bed, sitting in the chair next to the bed, and walking). The effect of early mobilization on respiratory indices was examined. Data were analyzed in SPSS version 18 using independent t-test, Chi-square and one way ANOVA statistical testes. Findings. There was no statistically significant difference between groups regarding demographic variables and underlying disease. Better lung function and arterial blood gases suitable changes were seen in the experimental group. Inspiratory capacity and arterial oxygen saturation was greater in the experimental than control group. Conclusion. Early mobility after open heart surgery is a safe and effective intervention and can have a positive effect on the patient's respiratory indices reducing pulmonary complications following surgery.

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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

Aim. The purpose of the present study was to examine the effect of supportive educational intervention on quality of sleep before coronary artery bypass grafting surgery.

Background. Patients who are waiting for surgery, experience high levels of stress and anxiety due to invasive nature of the procedure. This experience may influence their sleep quality. Disturbed sleep could lead to worsening the disease condition and reduces the process of recovery. Using non-pharmacological methods such as Benson muscle relaxation, deep breathing and guided imagery could be safe and useful for solving patients’ sleep problems before surgery.

Method. The present study was a quasi-experimental clinical trial in which 160 patients undergoing coronary artery bypass grafting surgery who hospitalized in cardiac surgery wards and cardiac intensive care units of selected hospitals of Tehran University of Medical Science were recruited and divided into two experimental (n=80) and control (n=80) group. Demographic data questionnaire was given to the patients at the first day of hospital admission. The control group received routine care. The intervention group received routine care and supportive educational intervention for at least two days between 4 and 6 p.m. All of the patients filled Groningen sleep quality scale in the day of surgery. Data analyzed by SPSS version 16.

Findings. Before surgery, the mean score of sleep quality was 4.6±5.50 in intervention group and 10.76±1.27 in control group.  There was a statistically significant difference between the experimental and control group in terms of sleep quality as the experimental group reported higher quality sleep than control group (P<0.0001).

Conclusion. Implementation of non-pharmacological methods such as relaxation, deep breathing, and guided imagery could be a good alternative method for hypnotic and sedative drugs. This could be one of the nursing interventions before coronary artery bypass grafting surgery as a safe, available and useful method.

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Abstract

Aim. The aim of this study was to examine the effect of early mobilization on hemodynamic parameters in patients undergoing coronary artery bypass graft (CABG) surgery.

Background. CABG is one of the most common surgeries that can increase quality of life and reduce mortality in most cases. It seems that early mobilization of patients from bed may reduce complications after surgery. The most important concern regarding early mobilization is the possible effect on hemodynamic parameters based on which this important intervention is neglected.

Method. In a clinical trial with 100 patients who were candidate for CABG. The patients were randomly assigned to experimental and control group. The experimental group were mobilized from bed in the first, second and third day after surgery. The control group received the hospital routine treatments and mobilization was done in the third day after the operation. The effect of early mobilization on hemodynamic parameters were compare between the groups. Other treatment programs were the same for both group. Data were analyzed in SPSS version 18 and using independent t-test, Chi-square and ANOVA statistical testes.

Findings. There was no statistically significant difference between groups regarding demographic variables and underlying diseases. In the experimental group, blood pressure was higher in the second and third days  compared with that control group. Chest tube drainage on the third day were 495±241 ml for experimental group and 556±285 ml for the control group, and no statistically significant difference was found between the groups in terms of chest tube drainage. None of the patients showed any complication during the mobilization.

Conclusion. The experimental group experienced a minimal increase in blood pressure, but it was not clinically significant. The results of this study indicate that early mobilization from bed in patients undergoing coronary artery bypass graft is a safe and applicable intervention, and don’t increase bleeding and acute hemodynamic changes.

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Abstract

Aim. This study aimed to determine the relationship of spiritual experiences with the life expectancy and death anxiety in patients undergoing coronary artery bypass grafting (CABG).

Background. The patients undergoing CABG experience a critical situation that requires taking into account such factors as life expectancy, spiritual experience, and death anxiety. During taking care of these patients, nurses must consider these experiences and their relationship.

Method. In this descriptive-analytic study, 150 patients undergoing coronary artery bypass surgery in hospitals located in Kerman city, Iran, were recruited within an 8 months period in 2015. Data were collected using a questionnaire including demographic data, Templer Death Anxiety Scale, Adult Hope Scale and the Scale of Daily Spiritual Experiences (DSES). Data were analyzed in SPSS version 20 using Pearson correlation test, Independent T-test, ANOVA and multiple linear regression.

Findings. There was a statistically significant negative correlation of daily spiritual experiences with death anxiety (p=0.004) and death anxiety with life expectancy (p≤0.0001). There was also a statistically significant positive correlation between spiritual experiences and life expectancy (p≤0.0001). Multiple linear regression analysis showed that age and life expectancy predicted 61 percent of changes related to spiritual experiences.

Conclusion. The findings suggest that paying attention to spiritual experiences of patients may increase life expectancy and reduce the death anxiety. It is suggested to include supporting, facilitating and attending to the spiritual needs of patients in nursing care plans for these patients.

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Abstract

Aim. The aim of this study was to examine the effect of incentive spirometry and deep breathing exercises on arterial blood gas parameters after coronary artery bypass graft (CABG) surgery.

Background. After CABG, pulmonary complications and oxygenation disorders are common and play an important role in post-operative mortality and morbidity. The different methods are being used for improvement of pulmonary function and oxygenation after CABG.

Method. In this clinical trial study, 75 patients who were candidate for CABG surgery were recruited and randomly allocated to two intervention groups (incentive spirometry group and deep breathing exercise group) and control group. The groups were compared in terms of arterial blood gas parameters (PaO2, PaCO2 and SaO2) before surgery, and on the first day, the second day, and the third day after surgery.

Findings. The study findings showed that in the third postoperative day, there was a statistically significant difference between intervention groups and control group in terms of the mean of arterial blood gas parameters (PaO2, PaCO2 and SaO2). 

Conclusion. Incentive spirometry and deep breathing exercise are both significantly effective on improvement of arterial blood gas parameters (PaO2, PaCO2 and SaO2).

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Abstract
Aim. The aim of this study was to examine the effect of Mindfulness-Based Stress Reduction (MBSR) on depression and anxiety in people with coronary artery disease (CAD) treated with coronary artery bypass graft (CABG) surgery. 
Background. Depression and anxiety are common in people with CAD treated with CABG. Therefore, it is important to investigate if effective therapeutic models can influence the negative emotions of these patients.
Method. The research method was single-subject and the statistical population of this study included all people with coronary artery disease who referred to Shahid Madani Hospital in Tabriz, Iran, during the second six months of the year 2016 for rehabilitation after surgery. The study sample consisted of four available people with CAD who received eight sessions of MBSR training by the researcher. The subjects were assessed before and after receiving the MBSR training by Beck Depression Inventory, and Beck anxiety Inventory. The data were analyzed through recovery percentage, percent of non-overlapping data (PND), standardized mean difference (SMD) and visual analysis of the charts. 
Findings. The findings showed that MBSR training reduced anxiety and depression in people with CAD following treatment with CABG.
Conclusion. Based on these findings, it be can concluded that MBSR is an effective treatment for management of negative emotions of people with CAD treated with CABG.

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