نشریه پرستاری مراقبت ویژه
سال چهارم شماره 2 (پیاپی 11، تابستان 1390)

Better understanding of the meaning of life in hemodialysis patients can lead to understanding the needs and style of their care.Therfore the purpose of this study was to describe the life experiences of patients from living hemodialysis unit. In this study, one of the qualitative research methods as descriptive phenomenology approach Collaizzi was used. The data were gathered through a semi-structured interview with 10 hemodialysis patients of Ekbatan University Hospital of Hamadan and Shohadaye Yaft Abad Hospital of Tehran. The Interviews was performed about the experiences of patients about the living with hemodialysis Unit in 2010. Four themes has been driven from the obtained results of this study which describe the structures of life experience of the hemodialysis patients with hemodialysis unit as fallow: hemodialysis as a irrefutable component of life, tensions of dialysis life, need to support and effective adaptation. The important life aspect of these patients was gradually moving from limitations toward the effective adoption against the inevitable process with all of its outcomes. Applying of the supportive sources in the patients for adaptability was different among the patients. These findings will give the nurses a new vision for real understanding of these patients and their more problems.

Hemodialysis patients undergo high levels of psychological stress, anxiety and depression. Therefore, the present study has been conducted to determine the effect of Hatha yoga exercises on stress, anxiety and depression among these patients. The present research is a two-group semi-experimental controlled trial done in 2010, in which 31 hemodialysis patients were selected from Shahid Labbafinejad hospital as the control, and 31 condition-matched patients from Baqiyatallah hospital as the case group, and Hatha Yoga exercise was performed for the experimental group for an hour twice a week during two months, after primary training by the yoga instructor. Data-collecting instruments included demographic information forms and a specific questionnaire on stress, anxiety and depression, which were evaluated before and two months after the intervention. Data were analyzed by SPSS16 statistical software using descriptive statistics, T-test, Chi-square, Fisher test and paired t-test. Analysis between the mean stress, anxiety and depression values of the study participants showed significant difference before and after the intervention in the case group (p<0.001). While this difference was not significant in the control group. Performing the low-cost, simple, and enlivening Hatha yoga exercise is accompanied by improving living conditions of hemodialysis patients, and a positive step can be taken toward improvement and prevention of the patient's psychological problems as well as other chronic disorders through applying these practices.

Unintentional accidents are the second leading cause of mortality in Iran. With the annual rate of 28 thousand deaths, Iran is one of the countries holding the highest accident mortality rate in the world. The aim of the present study was to identify and prioritize parameters affecting pre-hospital emergency preparedness in Iran. The present research is a kind of descriptive study with a comparative and functional approach which was performed cross-sectionally on the first half of 2010. Studied countries in the comparative section included the United Stat of America, England, France, Germany, Malaysia, Italy, Norway, Netherlands, and Canada. The study population consisted of 30 cases of the country pre-hospital emergency experts, selected through available sampling method. Data were collected using a questionnaire and were analyzed by MATLAB, SPSS17 and Visio software and DEMATEL technique. Determinants influential on pre-hospital emergency preparedness of Iran included organization, transportation, communication, accessibility, care model, manpower combination, regulation, and training. Rules and regulations with the coordinates of (1.36 and 2.18), and accessibility with the coordinates of (1.46 and 2.86) were identified as the most affecting and affected components respectively. To develop pre-hospital emergency system in Iran, legislating a professional emergency medical service, developing an independent organization of emergency medical services, as an observer and policy-making organization, and providing services based on one of Anglo's or Franco's models are necessary and highly required principles.

Emotional intelligence is a set of non-cognitive skills that enhances individual's ability to successfully encounter environmental pressures especially occupational burnout. Therefore, the present study was conducted to determine the relationship between occupational burnout and emotional intelligence. The present research is a type of correlation studies, which was performed cross-sectionally and with stratified random sampling method on 150 nurses of social security hospitals in Tehran in 2009. For data collection, Maslach's Burnout and Shrink's emotional intelligence questionnaires were used. Data were collected through Likert scale method, and were analyzed using t-test as well as Pearson correlation with the significance level of 0.05 and SPSS 17 software. There was a significant and inverse relationship between emotional intelligence and emotional exhaustion among nurses (p=0.016 and r=−0.234). There was a direct significant correlation between emotional intelligence and personal accomplishment (p<0.001 and r=0.0441). No meaningful relationship was observed between emotional intelligence and depersonalization (p=0.124 and r=−0.150). Furthermore, a remarkable difference was found between males and females in terms of emotional intelligence (p=0.048). Having emotional intelligence can lead to decreased occupational burnout; therefore, social security hospitals are recommended to attempt holding required training courses in order to reduce nurse's occupational burnout.

Given the lack of study in the field of vascular access care for hemodialysis patients and its important role in longevity of vascular access, this study aimed to assess the quality of vascular access care among hemodialysis patients. This cross-sectional study was conducted on 85 patients undergoing hemodialysis in Ali-Asghar hospital of Isfahan in the second half of 2010. Data were collected using a demographic questionnaire and a checklist related to vascular access care techniques, and analyzed by t-test and descriptive statistics and SPSS17 software. A total of 36 females and 49 males with an average of 46.44 months of hemodialysis were studied, among whom 25 patients underwent hemodialysis through subclavian catheters and 60 ones by arteriovenous fistula. The overall quality of care for vascular access site was moderate in 41.2% of cases. Selecting an inappropriately high speed for the apparatus at the beginning of dialysis, incomplete priming of the filter and the tubes, keeping open the outlet of arterial catheter while disconnecting the patient from the apparatus and needling of an aneurysm were the most common improper actions. Conclusion s: The overall quality of care for vascular access site has been in moderate level. Therefore, reinforcement of nursing continuing education programs and development of standard vascular access care protocols are recommended to improve care techniques.

The role of hands is well known as a leading cause of infection transmission in hospitals, and hands hygiene is the first step recommended for infection control. This study was conducted to evaluate hand hygiene behavior among critical care nurses. In this study in 2009, hands hygiene behavior was unobviously monitored in 159 hand-sanitizing situations among critical care units nurses, and their behavioral status as well as the patients profile and the performed procedure were recorded in a checklist designed based on national guidelines of disease control and protection. Data were analyzed by SPSS17 statistical software using descriptive analytical tests. The observed nurses wore glove in 150 situations (94.3 percent); whereas, they attempted to sanitize their hands only in 27 positions (16.98 percent), from which alcohol was used in 20 cases (74 percent), and soap and water and plain water in other situations. Most cases of hand hygiene were following the contact with patients. There was a significant relationship between the glove types used by nurses and infection risk of the observed procedure with hands hygiene (p <0.05). The study findings indicate that percentage of situations in which nurses attempted to sanitize their hands has been much less than expected.

Anxiety and depression have a high prevalence rate in patients with coronary artery disease, leading to reduced treatment outcome in these patients. Therefore, the present study has been conduced to compare anxiety and depression among patients with coronary artery disease based on proposed treatment. Anxiety and depression were compared through a standardized hospital anxiety and depression questionnaire (HADS) in 300 patients, in need of drug therapy, percutaneous coronary angioplasty (PCI), or coronary artery bypass graft (CABG), admitted to male cardiac unit of internal medicine department of Jamaran hospital, Tehran, in 2010, for coronary angiography. Data were analyzed by SPSS17 statistical software using ANOVA, Kruskal-Wallis, and chi-square. Incidence of depression was higher in patients candidate for CABG than the other two groups; likewise, level of anxiety was more in those with PCI as well as CABG compare to drug treatment group (p<0.05). In total, 38 and 45.7 percent of patients underwent some degrees of depression and anxiety respectively. Regarding high prevalence of anxiety and depression among patients with coronary heart disease and its negative impact on treatment outcome, appropriate screening and therapeutic approaches have to be applied for this group of patients.

Neonatal pain and stress response are manifested in three behavioral, physiological and chemical forms. Chemical changes in the pain include secretion and release of hormones and substances such as cortisol, insulin, endorphins and catecholamines. The present study aimed to compare the cortisol level in term infants with and without pain. In this pilot study in 2010, 30 infants who were admitted to the neonatal intensive care unit in Baqiyatallah hospital, divided into two 15-participant groups, with and without pain groups. Thereafter, the blood cortisol level was measured during the painful procedure of blood sampling. Pain or lack of pain was determined through Neonatal Infant Pain Scale (NIPS). Analyzing the data was done by using Mann-Whitney U test and Spearman coefficient correlation and SPSS17 software. Results indicated that cortisol level in both groups had no significant statistical difference (p>0.05); but, there was a significant and direct association between NIPS scores and cortisol level in all participants (p<0.05; r= 0.337). According to the obtained results, it seems that blood cortisol is not a reliable scale to evaluate the pain. However, it should be noted that, measuring the cortisol level and identifying its association and changes with pain, the time of blood sampling, attention to secretion rhythm of this hormone in 24 hours and infants’ age and their physica conditions should be highly considered.