فهرست مطالب

پرستاری داخلی - جراحی - سال هفتم شماره 3 (Aug 2018)
  • سال هفتم شماره 3 (Aug 2018)
  • تاریخ انتشار: 1397/06/17
  • تعداد عناوین: 7
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  • Morteza Barani , Seyed Mehdi Tabatabaei , Hamed Sarani , Alireza Rahat Dahmardeh , Aliakbar Keykhah * Page 1
    Background
    Pneumonia is one of the most common hospital-acquired infections, where 86% is associated with mechanical ventilation, known as ventilator- associated pneumonia (VAP). Oropharyngeal decontamination reduces the incidence of VAP by medicinal agents.
    Objectives
    The aim of the present study was to determine the effect of oropharyngeal decontamination using topical antibiotics on oropharyngeal and tracheal colonization of trauma patients admitted to the intensive care unit (ICU).
    Methods
    The present double-blind clinical trial was performed on trauma patients, who underwent endotracheal intubation during the first 24 hours, at the ICU of Khatam-al-Anbia Hospital, Zahedan, during years 2017 to 2018. The sample size was 100 individuals, who were selected using the convenience sampling method and randomly assigned to intervention and control groups. The study began with the start of intubation and lasted for five days. When oral and tracheal culture samples were sent to the laboratory during the first 24 hours after endotracheal intubation, the pre-mixed solution of nystatin, polymyxin B, and neomycin was rubbed to the mouth, lips, gingiva, and cheeks of the intervention group, using syringes and gloves, four times a day. The tracheal and oral secretions were cultured in the intervention and control groups at the beginning and the end of the study. Data analysis was carried out using the SPSS version 21 software. Independent t test and paired t test were used to compare the quantitative variables, and qualitative variables were compared using the chi-square test and Fisher's exact test. The significance level was considered at 0.05.
    Results
    When the final drop-out occurred, out of 44 remaining patients in the intervention group, the number of negative oral cultures increased from 31 cases (70.5%) in the pretest to 39 (88.6%) in the posttest. A total of 25 negative oral cultures were recorded in the control group in both the pretest and posttest stages. Also, the number of negative tracheal cultures in the intervention group increased from 38 cases (86.4%), in the first turn, to 44 (100%) cases in the second turn; while in the control group, the number of negative tracheal cultures was recorded as 39 (88.6%) in the first turn and increased to 40 cases (100%) in the second turn.
    Conclusions
    Clinically, reduced colonization rate of invasive bacteria, as the main result of the present study, indicates a decrease in the incidence of inappropriate alterations in oral microbial flora that can subsequently be effective in reducing the incidence of diseases, such as pneumonia.
    Keywords: Selective Oropharyngeal Decontamination, Intensive Care Unit, Oral Hygiene, Topical Anti-Infection Agents
  • Zahra Moudi*, Leyla Arabnezhad , Seyed Mahdi Tabatabaei Page 2
    Background
    Since maternal near miss (MNM) could act as a surrogate of maternal death, the implementation of MNM audit at hospital level can provide an opportunity to study maternal morbidity at a large scale.
    Objectives
    The current study aimed at investigating severe maternal outcomes (SMO; i.e. MNM + maternal death [MD]) in a referral hospital.
    Methods
    A prospective, facility-based, cross sectional study was conducted from 22 June to 22 December 2017. The current study was performed in a tertiary referral teaching hospital in Zahedan, Iran. The study population included all pregnant females with a gestational age of 22 weeks giving birth in this hospital or referred to this center for delivery, as well as females within 42 days of pregnancy termination. The World Health Organization maternal near-miss criteria were used to identify MNM and analyze the data. Logistic regression was used to predict SMO risk factors.
    Results
    Overall, 3527 deliveries and 3480 live births were reported in the hospital under investigation. Severe maternal outcomes were observed in 68 cases. The rate of MNM was 13.79 per 1000 live births; furthermore, the ratio of MNM to mortality was 12:1. Binary analysis showed that hemoglobin level, place of residence, parity, history of cesarean section (CS), insurance coverage, and type of delivery were the significant decisive factors in SMO. Moreover, severe hemorrhage and hypertensive disorders were the common causes of SMO.
    Conclusions
    According to the collected data, MNM indicators were high in the under study hospital. Therefore, it seems necessary to adopt context-based interventions at hospital level to find and manage mothers prone to SMO during pregnancy and childbirth.
    Keywords: Near Miss, Healthcare, Quality of Health Care, Maternal Mortality, Morbidity
  • Fateme Karimi , Fariba Yaghoubinia , Aliakbar Keykhah , Hassan Askari * Page 3
    Background
    Bedsore is a common problem in patients with stroke, causing an increased number of hospitalizations, increased healthcare costs, and mortality of these patients. Typically, due to their numerous problems, these patients are not able to take care of themselves and thus their care providers play an important role in providing care at their home.
    Objectives
    The present study was conducted with the aim of investigating home-based training on the incidence of bedsore in patients with stroke, during year 2017.
    Methods
    In the present clinical trial study, 70 family caregivers of stroke patients that had referred to Ali Ebne Abitaleb Hospital, Zahedan, Iran, were chosen through available sampling and then randomly assigned to control and intervention groups. In the intervention group, explanations were provided for the family caregivers about stroke, its resulting problems, bedsore, methods for preventing and caring for bedsore at home. The explanations were provided at the place of residence of the patient at the time of discharge as well as two and three weeks after discharge at home, and on the patient’s bedside. In the control group, on the other hand, routine trainings of the ward were given. After 12 weeks, both groups were evaluated in terms of incidence of bedsore, based on scoring presented by the National Pressure Ulcer Advisory Panel (NPUAP). Data analysis was performed by chi-square and t-test, using SPSS 21.
    Results
    The number of individuals in each group was 35. Frequency of incidence of bedsore after the intervention in the intervention and control groups was 25.7 and 48.6%, respectively. The statistical results indicated that there was a significant difference between the two groups in terms of frequency of bedsore (P = 0.046).
    Conclusions
    Home-based training is a practical and inexpensive method for participation of family members in providing care for patients with stroke and reducing incidence of bedsore in these patients.
    Keywords: Bedsore, Cerebral Vascular Accident, Home-Based Training, Patient Training, Family Caregivers
  • Parvaneh Hamidian , Nasrin Rezaee , Mansour Shakiba , Ali Navidian * Page 4
    Background
    Being involved in a serious crises, such as cancer, results in different reactions in humans, one of which is post-traumatic stress disorder (PTSD).
    Objectives
    This study aimed to determine the effectiveness of cognitive-emotional training on PTSD among women with breast cancer referring to the chemotherapy unit.
    Methods
    This randomized clinical trial was conducted on 85 patients with breast cancer in Imam Ali Hospital of Zahedan, Iran. The subjects were randomly divided into two groups of intervention and control. The intervention group was provided with five group cognitive-emotional training sessions. The data were collected using the PTSD questionnaire administered before the intervention and 12 weeks after the final training session. Data analysis was performed by SPSS21 using the Independent t-test, Chi-square test, and Paired sample t-test.
    Results
    According to the results, the mean PTSD in the posttest and mean changes in stress scores of the intervention group were 32.13 ± 8.51 and -26.67 ± 13.75, respectively. These mean scores were significantly less than those in the control group (51.38 ± 13.91 and -8.21 ± 8.09, respectively) (P = 0.001).
    Conclusions
    Cognitive-emotional intervention had a positive effect on PTSD among women with breast cancer. Therefore, this method is recommended to be included in the care program of women with breast cancer.
    Keywords: Posttraumatic Stress Disorder, Breast Cancer, Clinical Trial, Cognitive-Emotional Training
  • Saeid Hashemi*, Ali Tayebi , Abolfazl Rahimi , Behzad Einollahi Page 5
    Background
    Compliance with dietary and fluid restrictions is an integral part of treatment in hemodialysis patients. In fact, non-adherence to these restrictions could entail serious consequences.
    Objectives
    The present study was conducted to explore the impact of continuous care model on compliance with dietary and fluid restrictions in these patients.
    Methods
    The current study was a clinical trial with a control group, which was carried out on 98 hemodialysis patients at two hospitals in Tehran. The subjects were chosen via purposive sampling and randomly assigned to the treatment and control groups. The treatment adherence questionnaire was completed by both groups in the pretest. Afterwards, in the treatment group, once the subjects were presented with the educational manual, a continuous care model was implemented for them. The model consisted of four stages, including awareness-raising, sensitization, control, and evaluation. At the end of three consecutive months, the questionnaire was completed. In the control group, the questionnaire was similarly completed except the subjects had not been exposed to any intervention. Data were collected using descriptive tests, chi-square, t-test, and a repeated measures design. The results were analyzed with the SPSS 21 software.
    Results
    The findings showed that the pattern of adherence to dietary and fluid restrictions in the two groups was statistically significant over time (P < 0.001) such that changes in the intervention group were indicative of the positive effects of continuous care on compliance with dietary and fluid restrictions among hemodialysis patients.
    Conclusions
    By implementation of the continuous care model, the patients, through counseling and training, developed a greater adherence to their dietary and fluid restrictions. Hence, it is suggested for ICU nurses to make use of this model to prevent complications and improve quality of life of hemodialysis patients.
    Keywords: Continuous Care Model, Dietary Compliance, Fluid Restriction Adherence, Hemodialysis
  • Alemeh Dehnabi , Hamid Radsepehr , Hassan Navipour * Page 6
    Background
    Diabetes mellitus is one of the most common chronic diseases that causes various complications. Glycosylated hemoglobin is a reliable indicator of diabetes.
    Objectives
    The purpose of the present study was to assess the impact of discharge planning on improving glycosylated hemoglobin in patients with type 2 diabetes.
    Methods
    This is a quasi-experimental study which was conducted in Vasei Hospital, Sabzevar, in 2014. The subjects of this study included 70 patients with type 2 diabetes who were chosen non-randomly through convenience sampling. The subjects were divided into the intervention and control groups.
    Results
    The findings showed a significant difference between the control and intervention groups in terms of mean value of glycosylated hemoglobin obtained in the post-test (7.25 versus 8.16, P < 0.001). Controlling the effects of the pre-test, the authors observed similar results obtained via covariance analysis.
    Keywords: Glycosylated Hemoglobin_Nurse_Type 2 Diabetes_Discharge Planning
  • Leila Valizadeh , Vahid Zamanzadeh , Saman Saber , Toktam Kianian * Page 7
    Context: Increasing life expectancy and the rise in the cost of long-term care at hospitals have led global healthcare systems towards offering home care services. Thus, identifying barriers to this valuable type of care can be an effective step in achieving health-related goals. This study was carried out to determine the challenges faced by home care centers. Evidence Acquisition: This research was conducted as an integrative review in 2018, whereby a wide range of keywords, such as home care, home care nursing, challenges, barriers, and their equivalents in Persian language were used to retrieve related articles. Certain valid Persian and international databases, including EBSCO, EMBACE, SienceDirect, Scopus, MEDLINE, Google Scholar, IranDoc, CINAHL, IranMedex, Magiran, and SID were utilized in order to search for relevant articles. Among papers written in Persian or English, which were useful for the purpose of this study with their full text being accessible, 39 articles were chosen and analyzed using the Broome (indirect cohort) method.
    Results
    In the process of data analysis, the challenges faced by home care centers were revealed. They included non-application of standard and integrated methods for home care nursing services, deficiency in intra- and extra-organizational communications, absence of proper organizational infrastructure, lack of adequate and effective human resources, absence of legal and security supports, economic problems, information poverty, cultural constraints and ignoring ethical issues.
    Conclusions
    There are many challenges and barriers to home care services; these are often intertwined and each is the cause or effect of others. This wide range of challenges and obstacles require coordination, as well as a comprehensive and accurate programming.
    Keywords: Home Care Services, Nursing, Challenges, Integrative Review