نشریه پرستاری مراقبت ویژه
سال هفتم شماره 2 (پیاپی 23، تابستان 1393)

Foot massage has is important to improve quality of sleep. The purpose of this study is determining the effect of foot massage on quality of sleep in ischemic heart disease patients. in this clinical trial study 60 patients participated and randomly divided in the two groups: intervention (n = 30) and control (n = 30). In intervention group, foot massage was performed two nights. Quality of sleep was assessed by SMSHQ and analyzed by SPSS software and using statistics tests (chi-square, Test, Paired samples Test). Results showed significant differences (P=0.002) between before and after foot massage in quality of sleep in intervention group. But the quality of sleep between before and after the usual care in control group has no significant difference (P = 0.964). T-test showed no significant differences (P=0.64) between before foot massage in quality of sleep in intervention and control groups, But after the intervention there was significant difference (P = 0.01). Foot massage improves sleep of patients with heart disease and due to the low cost and safe procedure, it recommended in these patients.

Acute Coronary Syndrome (ACS) is a common cardiovascular disease. In patients with this disease, symptom management is performed both pharmacologically and non-pharmacologically. One of the non-pharmacologic symptom management interventions is chest local heat therapy. The aim of this study was to determine the effect of chest local heat therapy on physiologic parameters in patients with ACS. We conducted this randomized double-blind placebo-controlled clinical trial in 2013—during six months in Cardiac Care Unit of 22 Bahman hospital in Gonabad, Iran. In this study, we randomly allocated 66 patients with ACS to two placebo and experimental groups. Patients in the experimental and control groups received chest local heat therapy by using a hot pack warmed to 50°C and 37°C respectively. Local heat therapy was administered for four 23-minute sessions in the anterior part of the chest. The levels of patients’ heart rate, respiratory rate, arterial blood pressure and blood oxygen saturation were measured both before and after the intervention. Data collection tools consisted of a demographic questionnaire and a data sheet for recording physiologic parameters. Data were analyzed by using SPSS 16 software and descriptive and inferential statistical tests. there was no significant difference in the two groups before and after the intervention in terms of systolic and diastolic blood pressure as well as heart rate. However, in compare with before the intervention, systolic and diastolic blood pressure in the experimental group were decreased significantly (p<0.05). Moreover, before the intervention, there was no significant difference in the two groups in terms of respiratory rate and oxygen saturation. However, after the intervention, respiratory rate in the experimental group in compare with before the intervention and placebo group were decreased significantly and oxygen saturation was increased significantly (p<0.05). The study findings confirmed the effectiveness of local heat therapy in improving physiologic parameters in patients with ACS.

Hemodialysis is one of the main treatments for patients with chronic renal failure. If performed hemodialysis does not have necessary efficacy, the rate of patients’ mortality increases. One of the most important measures in this area is to prevent clot formation which can be achieved by using proper administration of anticoagulants (heparin). Therefore, present study aimed to comparison of two methods of heparinizing hemodialysis set effects on the rate of dialysis adequacy in hemodialysis patients. In a quasi-experimental study, 176 hemodialysis patients admitted in the dialysis centers of Kermanshah Medical Sciences University who had inclusion criteria were under the two methods of anticoagulation with heparin (continuous infusion or intermittent bolus group) through convenient sampling method. In order to evaluate the adequacy of dialysis of Urea Reduction Ratio (URR) and KT / V were used. The study was conducted in before and after comparative form. Data collection tools include demographic and background features and the checklist of doing hemodialysis. Finally, data were analyzed by SPSS16 statistical software. Results showed that comparing dialysis adequacy based on URR and KT / V mean in the two methods did not have statistical significant difference. Both continuous infusion and intermittent bolus have almost the same effect on dialysis adequacy.

A person’s complete health depends on the balance between his existential dimensions. Spiritual care has been identified as the most important and helpful factor in achieving balance in health maintenance and disease resistance. Considering soothing role of sleep in complete health of human and its high importance for cardiac patients; this study was carried out to determine the effect of spiritual care based on GHALBE SALIM model on sleep quality in patients with coronary artery disease. In this two-group controlled clinical trial study, sixty patients with acute coronary syndrome in the coronary care units of Baqiyatallah hospital in Tehran in 2013 were selected by purposeful sampling method and they were randomly allocated in two experimental and control groups. By using Pittsburgh Sleep Quality questionnaire, patient's sleep quality was measured on the first day after admission. In experimental group, spiritual care program was performed from the first day of admission to the time of discharge. After two months, sleep quality of the samples was measured. Data of the study were analyzed by using descriptive statistics (mean, standard deviation and frequency), inferential statistics (chi-square, paired and independent t, Mann-Whitney U, Wilcoxon) and SPSS18 software. Total PSQI score in experimental group was decreased significantly after the intervention in compare with the time before the intervention (p=0.001).Total PSQI score of the experimental group after the intervention was significantly different in compare with the control group (p=0.001) Spiritual care based on GHALBE SALIM model improved the sleep quality of patients. As a result, the achievement of peace and freedom from stress due to disease helped the patient’s psychological adaptation to the disease and also helps the patient’s current treatment status and health indirectly.

Many factors such as positive pressure ventilation, lack of coordination between the patients and ventilator, suction, patient’s position and physiologic factors can influence endotracheal tube cuff pressure. The purpose of this study was to determine the relationship between core body temperature and changes of endotracheal tube cuff pressure. this descriptive analytical (correlational) study was done in 2012 in Intensive care unit of Imam Reza hospital in Kermanshah. In this study, 259 intubated patients recruited with convenient sampling method. Endotracheal tube cuff pressure and core body temperature were measured twice in the 6-hour intervals. Data analysis was performed by using SPSS-16 software, descriptive and analytic statistic including Wilcoxon test and Spearman correlation coefficients. In 65% of patients, cuff pressure was out of the standard range in the first measurement of cuff pressures. At the second time, after correction of cuff pressures, it decreased to 20% of patients. There was significant difference between average of core body temperature before and after correction of cuff pressure (p≤0.001), but there was not statistically significant relationship between core body temperature and changes of endotracheal tube cuff pressure before and after the correction of cuff pressure. The results showed that there is no relationship between core body temperature and changes of endotracheal tube cuff pressure. However, regular monitoring of cuff pressure and core body temperature of patients hospitalized in Intensive Care Unit (ICU) is recommended and further investigations are suggested.

Nosocomial infections are the most important problems in health care centers and for patients that are in the intensive care unit. Evidenc based guidelines for the prevention of nosocomial infections can be a significant impact in reducing these infections. Therefore, this study was performed and aimed to design and accreditation evidence based guidelines for prevention of nosocomial infections in the intensive care unit. This “developmental research” method was performed in intensive care unit in 1392. The quality of 32 guidelines was assessed with the valid and reliable check list. Then Evidence based new guidelines based on Estetler's model were designed to prevention of nosocomial infections. The quality of designed guidelines was assessed with the same check List. Data analysis was performed using descriptive statistic and SPSS17. The quality of 32 available guidelines was poor (84.37%) and 15.63% was moderate. 18 nosocomial infections preventive guidelines were designed that 100% of them had well quality. Given the importance prevention of nosocomial infections and since the quality of available a guidelines is not good; evidence-based guidelines can reduce the risk of infection in patients.

Cardiovascular diseases are the main causes of death in diabetic patients; so that acute myocardial infarction (AMI) symptoms differences in diabetic and non-diabetic patients may influence diagnosis of the disease and the decision time for treatment and consequently disease outcomes. This study was conducted with the aim of investigating the differences of clinical manifestations between diabetic and non-diabetic patients with myocardial infarction. This cross–sectional study was done on 366 patients with acute myocardial infarction hospitalized in Cardiac Care Unit (CCU) in 2013. Demographic information form and symptoms check list were used and symptoms of acute myocardial infarction (AMI) were asked from the patients and the results were entered into the checklist. Results were analyzed through SPSS20 software, descriptive statistics methods and odds ratio. Results showed that diabetes increases chance of dyspnea, weakness, fatigue, belching, tinnitus, anxiety and hiccup. From the other side being a diabetic patient increases the chance of pain related to AMI in the neck, left shoulder, and the left arm. Atypical symptoms, particularly in diabetic patient, may cause delay in patient’s referring and also decision making for the diagnosis and treatment by the medical team as well; so staff of intensive units and the patients need more and specialized information regarding knowledge about AMI symptoms specifically by noticing diabetic disorder.

Angina pectoris with impaired function in bearing activity reduces patients’ quality of life of the. Studying specific quality of life is an important measure in impact of disease, treatment and other variables affecting patients’ lives. The aim of this study was to determine different dimensions of the specific quality of life of the patients with angina pectoris and its related factors. In this study, 200 inpatients or outpatients with angina pectoris referring to two selected educational-treatment centers of Qum were selected via convenience sampling method in 2012. Seattle Angina Questionnaire (SAQ) and demographic Questionnaires were used as data collection tools. Data analysis was done in SPSS 16 software environment by using descriptive statistical, Pearson correlation coefficient, independent t-test, ANOVA and ANCOVA. The highest and the lowest scores of life quality were related to the treatment satisfaction with mean and standard deviation of 66.34 ± 17.32, and mean and standard deviation of angina stability was 38.92 ± 24.02. There was significant difference between gender, occupation, marital status, number of hospitalizations, CCS classification, angina severity and type of treatment with dimensions of quality of life (p<0.05). Quality of life of the patients with angina pectoris is not appropriate regarding angina stability and disease understanding. It seems necessary to pay more attention to nursing and treatment cares to enhance and improve the quality of life for these patients.