فصلنامه پرستاری قلب و عروق
سال هفتم شماره 1 (پیاپی 25، بهار 1397)

Aim. This study aimed to compare physicians’ and nurses' perceptions of futile care.
Background. Futile medical care is the provision of medical care or treatment to a patient when there is no reasonable hope or chance of a benefit. Determination of perceptions of futility is crucial to reduction of situations leading to futility and end-of-life decision-makings.
Method. The present study is a descriptive-comparative cross-sectional study in which 114 nurses and 57 physicians working in intensive care units of selective teaching hospitals of Shiraz University of Medical Sciences were recruited by convenience sampling method based on the inclusion criteria. The data collection instrument was a researcher-made questionnaire of futile care perception whose validity and reliability was assessed by experts, test-retest and Cronbach's Alpha methods. The Data were analyzed using descriptive and analytical statistics in SPSS software version 16.
Findings. The mean score of physicians’ and nurses’ perceptions of futile care was 77.29±13.79. The mean score of nurses’ perception was 78.46±14.4, turned out to be higher than that of physicians (74.91±12.3). The highest level of consistency between the two groups was related to the item "ineffective communication" and “disregarding the members in the decision-making process by the ICU attending physician”. As for "stressfulness of futile medical care", nurses experienced higher stress levels and there was a statistically significant difference between the two groups in this regard.
Conclusion. The agreement on the most important factors affecting the perception of futility indicates consistency between physicians’ and nurses’ perceptions of futile care. The high perception scores in both groups, and the stressful nature of futile medical care require necessary training mechanisms needed to deal with such situations

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

Aim. The purpose of this study was to compare the effect of “acceptance and commitment therapy” and “stress inoculation training” on stress symptoms in people with broken heart syndrome.
Background. Stress is considered to be the main driving force of broken heart syndrome, while broken heart syndrome also causes stress. It seems that training the patient for correct use of coping strategies during stressful events is effective in preventing recurrence.
Method. In this quasi-experimental pre-test post-test design with control group, 62 people referred to Tohid Hospital in Sanandaj during 2016-2017 and had been diagnosed as with broken heart syndrome were considered as accessible population, out of which 30 patients were recruited by convenience sampling method and randomly assigned to three groups. Research tool was the stress syndrome scales in Persian language. For intervention groups, the acceptance and commitment therapy and stress inoculation training interventions was conducted in weekly sessions. The questionnaire were filled out before intervention, after intervention and one month after intervention by the three groups. Data were analyzed in SPSS using descriptive and inferential statistics.
Findings. Compared with control group, acceptance and commitment therapy (F=87.65, P≤0.0001) and stress inoculation training (F=61.18, P≤0.0001) were effective in reducing stress symptoms and the effect of the acceptance and commitment therapy was remarkable. In addition to the stability of the effect of both interventions one month after intervention, the effect of acceptance and commitment therapy was found to be superior to stress inoculation training.
Conclusion. Both modalities; especially acceptance and commitment therapy, can be used as effective methods with wide applicability in preventing and reducing symptoms of stress and improving the status of people with broken heart syndrome.

Aim. The purpose of this study was to compare the effect of clinically-indicated replacement and routine replacement of peripheral venous catheters on catheter-related complications and satisfaction in patients undergoing cardiac surgery.
Background. The insertion of peripheral vein catheter is one of the most commonly used minimally invasive measures in hospitalized patients. Catheters can be maintained until they are working well.
Methods. A randomized controlled clinical trial was conducted in intensive care units of Rajaie Cardiovascular Medical and Research Center in 2017. After ethical Approval, 104 Patients were randomly allocated to either clinically-indicated replacement or routine replacement of peripheral venous catheters (every 96 hours) (52 Patients in each group). Data collection tools included demographic form, catheter placement data sheet and a researcher-made patients’ satisfaction questionnaire. Data were analyzed in SPSS using descriptive and inferential statistics.
Findings. There were no statistically significant difference in terms of the incidence of complications between the groups. Also, there were no statistically significant difference between the scores of satisfaction of the patients of the control and experimental group.
Conclusion. No evidence was found of superiority of routine replacement of peripheral venous catheters over clinically-indicated replacement. Caregivers may consider changing the protocol of catheter replacement from routine replacement to clinically-indicated replacement. This would protects patients from the unnecessary pain of routine replacement in the absence of clinical indications.

Aim. The purpose of this study was to determine the effect of teaching health-promoting behaviors on self-care behaviors in people with hypertension.
Background. Hypertension is one of the chronic diseases that causes serious complications on the organs of the body and requires self-care behaviors to be managed and controlled. Education increases self-care capacity in these patients and may help reducing complications and promote disease control.
Method. In this quasi-experimental study, 106 patients who referred to the clinic of Shahid Rahimi Hospital in Khorramabad, affiliated to Lorestan University of Medical Sciences, were recruited based on inclusion criteria and allocated to experimental (n=53) and control group (n=53). The experimental group received three training sessions of health-promoting behaviors in three consecutive weeks. The control group received only the routine treatments. Data were collected using a demographic form and self-care behaviors questionnaire, before and one month after intervention. Data were analyzed by SPSS version 22 using descriptive and inferential statistics.
Findings. The groups did not differ significantly in terms of demographic variables and disease characteristics. Before intervention, the mean score of self-care in the control and experimental group were 8.33±1.79 and 9.7 ±2.41, respectively, and there was a statistically significant difference between the groups (P=0.002). After intervention, the mean score of self-care in the control and experimental group were respectively reported as 8.43±1.84 and 14.46±2.13. Analysis of covariance showed that after intervention, the mean score of self-care in experimental group was significantly higher than that of control group (P≤0.0001).
Conclusion. Education improved self-care in people with hypertension. Providing education for people with hypertension can be effective in promoting their self-care behaviors.

Aim. The purpose of this study was to determine the role of caregiver burden, marital stress, and minfulness in predicting the level of psychosocial adjustment to illness in people with coronary artery disease.
Background. Cardiovascular disease and its consequences are not limited to the patient, but also have a great impact on the caregiver's life.
Method. This was a descriptive correlational study. The statistical population was all people with referred to the hospitals and medical centers of Urmia with diagnosis of coronary artery disease within the first half of the year. The sample consisted of 130 patients who were selected by convenience sampling method. Data were collected using the questionnaires caregiver burden, marital stress, Kentucky Mindfulness Skills and psychosocial adjustment to illness. Data were analyzed in SPSS by descriptive and inferential statistics.
Findings. The results showed that caregiver burden and marital stress had a statistically significant negative correlation with psychosocial adjustment. Among mindfulness subscales, only “describe” subscale had a statistically significant positive correlation with psychosocial adjustment to illness (P=0.04). The stepwise regression analysis showed that the research model was able to explain 57% of psychosocial adjustment to illness. These findings suggest that caregiver burden and marital stress play an important role in psychosocial adjustment of patients with disease.
Conclusion. It can be concluded that caregiver burden and marital stress play an important role in the primary and secondary prevention of coronary artery disease, and intervention based on the results of this study is recommended.

Aim:  This study reviews the role of vitamin E in cardiovascular diseases. Cardiovascular diseases are among the most common health-related problems, and the number of the patients with cardiovascular diseases increases each year. Long-term manifestations of cardiovascular disease bears a lot of cost to the family and society. This review study was conducted by searching out the related literature in the databases Google Scholar, PubMed, PMC, Springer, and Elsevier, for papers published from 2014 to 2018. Initially, a total of 72 articles were found and the number of articles was reduced to 42 by removing duplicates and articles that were only accessible as abstract. Finally, a review by 21 articles was carried out. α-Tocopherol is the most common form of vitamin E in human tissues. Increased oxidative stress is an important mediator of endothelial injury in hypertension pathology, associated with increased oxidant protein production, such as hydrogen peroxide super oxidation, decreased nitric oxide synthesis, and decreased biological capacity of antioxidants. Oxidative stress may lead to endothelial dysfunction, inflammation, hypertrophy, fibrosis, and angiogenesis associated with hypertensive vascular changes. Vitamin E deficiency can provide a constraint for micro ribonucleic acids (miRNAs) networks, and this may lead to the progression of atherosclerosis. Vitamin E deficiency causes adverse effects in cardiovascular systems. However, the effect of its use in the treatment of diseases is still not fully understood. A good amount of Vitamin E should be provided and it should be replaced before the complications occur.

This paper reviews the potential role of hypertensive disorders of pregnancy (HDP) as a risk factor for cardiovascular disease (CVD).

CVD is one of the most important causes of mortality. Paying attention to the risk factors of CVD is of great importance in reducing mortality, the cost of treatment and care and improving health indicators. Over the recent years, HDP have been considered as a risk factor for developing CVD in later life.

This review study was conducted by searching out PubMed, Scopus, and Springer databases from 2016 to 2019, based on the availability of articles full text. The keywords included “hypertensive disorder of pregnancy AND cardiovascular disease AND risk AND screening”. At first, 223 articles were found that according to the title and with the elimination of repetitive and non-English language studies, the number of articles was reduced to 17, and 10 papers were reviewed.

Within the recent years, the incidence of CVD in women with a history of HDP has been considered. The main discussion in numerous studies has been focused on whether the presence of risk factors for CVD before pregnancy leads to HDP and then occurrence of hypertension in later years, or HDP is the risk factor for the onset of CVD in the future.

Pregnancy is considered as a stress test that unveiling CVD, therefore, it is important that the history of HDP to be considered in the list of risk factors for CVD in postpartum years. Annual blood pressure and renal function monitoring, lifestyle modification and paying attention to the CVD risk factors in this group of women is recommended.