مجله مراقبت پرستاری و مامایی ابن سینا
سال بیست و هفتم شماره 3 (پیاپی 69، امرداد و شهرویور 1398)

Patients admitted to the intensive care unit express the chest tube removal as one of their worst experiences. In spite of scientific advances, no effective action is taken to reduce the pain due to it. Therefore, the aim of this study was to investigate the effect of respiratory relaxation on the severity of pain resulting from the removal of chest tube after coronary artery bypass graft.  This single blind randomized trial was performed in 2016 on 80 patients with open heart surgery with only one mediastinal chest tube. Patients were randomly divided into case and control groups. In the case group, relaxation and relaxation breathing exercises were used for 5 minutes before the tube was exhausted. The severity of pain was measured by visual analog scale before, immediately and 15 minutes after the removal of the chest tube. Data analysis was performed using common tests. The results showed that there was no significant difference between the severity of pain in both groups before the removal of the chest tube (P=0.84). It was also found that there was a significant difference between the severity of pain immediately after the discharge of the tube in the case group (P=0.0001), but there was no significant difference between the intensity of pain 15 minutes after the withdrawal of the tubes in the case and control groups (P=0.21). Respiratory relaxation is an effective technique for the pain intensity of postoperative chest tube after open heart surgery. It is recommended to use this method before tubing, due to lack of cost, ease of use and effectiveness.

Hospitalization is one of the main causes of anxiety in children. The purpose of this study was to determine the effect of preparation for hospitalization on anxiety during admission of school-age children in Hamadan Beast Hospital in 2017. In this quasi-experimental pretest-posttest control group study, 54 school-age children (6 to 12 years old) referred to the children departments (1 and 2) of Besat Hospital of Hamadan were randomly assigned to two groups. A demographic questionnaire and Spielberger anxiety questionnaire were used to collect data. In the treatment group, after completing the questionnaires, the preparation program was provided: this included familiarizing the child with the department and personnel, the tools, and presentation of a cartoon booklet for 30 minutes. For the control group, the usual tasks of the department were applied, after which the questionnaires were re-filled by both groups. Data was analyzed using SPSS 16, Fisher and Chi-square tests. The mean of anxiety scores before and after intervention was significantly different in the control group (P=0.001), and there was a significant difference between the intervention group before and after the intervention (P=0/050), which indicates the positive effect of the intervention on reducing the anxiety of school-age children. The program of pereparation for hospitalization is an effective method for decreasing the anxiety of school-age children.

Severe nurse shortages and their turnover have made researchers focused on identifying the factors affecting the retention of nurses and relationships between these factors. The aim of this study was to investigate the relationship between organizational justice and Nurses’ job embeddedness in Teaching Hospitals. In this descriptive-analytical study, data was collected from 215 nurses working in two educational hospitals in city of Birjand who were selected by stratified random sampling. Crossley et al Global Job Embeddedness Scale and Niehoff and Moorman’s Organizational Justice Scales were used to measure the studied variables. Data was analyzed by SPSS 16 using independent t-test, one way ANOVA, Tukey’s post-hoc test, Pearson’s correlation coefficient and multiple regression analysis at a significance level less than 0.05. Based on the results, the level of job embeddedness of nurses was higher than the average (3.05±1.07), and men had more embeddedness than women. In this study, from dimensions of organizational justice, the dimensions of interactional justice showed the highest correlation with job embeddedness. Multiple regression analysis showed that interactional justice and distributive justice predicted 34.6% of changes in job embeddedness (F=37.20, P<0.001), and interactional justice was a better predictor of job embeddedness compared to distributive justice. The results demonstrated the necessity of implementing programs to improve the Nurses’ job embeddedness, especially female nurses, through increasing the perceived organizational justice, especially the dimensions of interactional justice and distributive justice.

Adherence of standards requires the continuous of education for nurses. Effective educational methods for increasing knowledge and enhancing skills is group discussion. The purpose is to determine the effect of education of medication by small groups discussion on nursing adherence in intensive care units of medication Standards. In this semi-experimental study the intensive care units of two hospitals that were randomly assigned as intervention and control groups 76 nurses were enrolled in the census. The medication standards checklist was designed in 25 sections and 53 questions. The researcher using the checklist, controlled each nurse’s adherence of the medication standards in four steps before and after the education, subtle and direct observation. If adherence score 1 and in non adherence score zero was earned. The education of medication standards was conducted in the intervention group by group discussion method during two sessions of two-hours. Data analysis was performed using SPSS 16 and independent t-test and paired t-test. There was no statistically significant difference between the two groups in term of the rate of adherence of nurses from the medication standards before intervention (P>0.05). After intervention, nurses’ adherence significantly increased in the intervention group (87.9±2.5) compared to the control group (77.7±2.7) (P<0.001). Considering the positive effects of education using group discussion method on nursing adherence of medication standards and the importance of this issue regarding the care of patients, using this method for nurses’ education is suggested.

One of the important factors for behavioral changes in chronic patients, especially cardiac patients, is the increased self-efficacy of these patients. The aim of this study was to determine correlation between defenses mechanism and self-efficacy in Ischemic Heart patient’s referred to Feiz hospital of Isfahan in 2017. This study was a correlational analytical study that consisted of all Ischemic Heart patient’s referred to Feiz hospital of Esfahan in second half of 2017. Based on inclusion criteria and census sampling, 150 patients were included. To collect data we used three questionnaires: demographic, Defense Styles Questionnaire-DSQ and Sullivan’s cardiac self-efficacy questionnaire. Data was analyzed using SPSS 19, Kolmogorov–Smirnov test, independent t-test, and Pearson correlation coefficients. Based on the results, 53.3% of patients were male, 76% of whom were married and 32% had undergraduate education. Findings showed the rate of defense mechanisms with a mean of 193.07±28.45 and their self-efficacy with a moderate mean. Pearson correlation coefficient showed that there is a positive and significant correlation between the developed defense mechanisms with self-efficacy of patients (r=0.20, P=0.013).  The results of the study indicated that there is a positive and significant relationship between using defense mechanisms and predicting the self-efficacy of patients with ischemic heart; that means by using grown defense mechanisms, the self-efficacy will upgrade. So training and enhancement of developed mechanisms and reduction of unhealthy mechanisms by nurses is suggested.

Pain management in children with burn is one of the most important issues in pediatric medicine. Non-pharmacological methods of pain control can play an important role in patients. Therefore this study was conducted to investigate the effect of medical directed play on the severity of pain during burn dressing change. To conduct this two-group clinical trial, 78 children of 3-6 years old with burn surface area ranging less than 25% who had referred to Shahid Motahari Medical Center for their first burn dressing change, were selected. After obtaining the ethics approval for conducting the study, the patients were placed as random allocation in control and intervention groups. For the intervention group, the pre-dressed directed medical play was done and routine care was taken for the control group. The FLACC scale was used in both groups to measure the severity of pain before and during the dressing; the arterial blood oxygen level and heart rate were also measured and compared. For data analysis, SPSS 20 was used.  There were significant differences between the two groups during burn dressing change of mean pain (P=0.041) and pulse (P=0.037), and the mean of both indices in the control group was high. The mean of the arterial blood oxygen level during burn dressing change did not differ significantly between the two groups (P=1). Directed Medical play effectively reduces the pain of pediatric burn dressing change. This technique is cost-effective, so it can be widely used for pain management in pediatric department.

Due to the chronic and progressive nature of chronic renal failure, the hemodialysis patients’ need for caregivers to carry out daily care increases; as a result of this care, caregivers are also exposed to a wide range of psychological and physical problems. One of the psychological symptoms experienced by caregivers is death anxiety. This study was conducted to determine the predictors of death anxiety in caregivers of hemodialysis patients. In this cross-sectional descriptive study (May to Jun 2018), 176 caregivers of hemodialysis patients were selected using convenience sampling method from hemodialysis centers of Qazvin. A demographic characteristics questionnaire and Templer Death Anxiety Scale (TDAS) were used to collect data. Data analysis was performed using descriptive and inferential statistics including multiple linear regression in SPSS 23. The mean score of caregivers’ death anxiety was 48.37±9.18. Multiple regression results showed that gender (b=4.163, P<0/05), caregiver’s relation with patient and simultaneous responsibility for caring other patients were significant predictors of death anxiety. The coefficient of determination indicated that the independent variables of the regression model explain 20.7% of the changes in death anxiety. Considering the important role of caregivers of hemodialysis patients, paying attention to psychological complications of this population such as death anxiety and its effective factors are important. Based on these variables, support and educational programs can be conducted to control the death anxiety in caregivers.

The diagnosis of cancer among children is a life-changing event for themselves and their family. The present study is a semi-experimental pretest-posttest with control group. The statistical population of the study included all mothers with a child with leukemia who referred to the oncology department of 17 Shahrivar Hospital in Rasht city. Thirty mothers who had a child with leukemia were randomly divided into two groups: relaxation training (15) and control group (15). Then, they completed questionnaires of general health questionnaire (GHQ) and Scale of Resilience in three stages of pre-test, post-test and follow-up. The training group received relaxation techniques for 2 months (8 sessions of 2 hours). After 2 months, the follow up was performed. Data was analyzed using SPSS 19 and by Covariance and repeated measure ANOVA. Mancova showed that the training of relaxation techniques in post-test stage has a significant effect on physical complaints, social anxiety and depression and increases resiliency (P<0.01). The results of repeated measures analysis of variance showed that the effect of relaxation techniques on mental health indicators, anxiety (P<0.01) social withdrawal and depression (P<0.05) and resiliency (P<0.01) remained up to follow up stage. According to the results, it can be said that the training of relaxation techniques should be part of the treatment plans for mothers with cancer in hospitals and counseling centers.