Evidence Based Care
Volume:10 Issue: 3, Autumn 2020

Critically ill neonates receiving blood products are at risk of transfusion-related complications. The quality of nursing care in this regard can be enhanced through continuous evaluations.

This study aimed to assess the performance of nurses in a neonatal intensive care unit (NICU) regarding the transfusion of blood and blood products.

This descriptive cross-sectional study was carried out on the nurses working in an NICU in Tehran, Iran, during 2017. The performance of nurses was investigated for 550 blood transfusion procedures by structured observation through a researcher-made checklist with 40 items in three steps. The data were analyzed using SPSS software (version 22) using descriptive statistics and a generalized estimating equation.

The highest frequency (66.2%; n=365) of transfusions was observed for fresh frozen plasma. In the pre-transfusion phase, no case out of 550 transfusion procedures, ensuring the openness of the vein with normal saline injections run (100%), the carriage of blood products from the blood bank to the ward by the box Specific (76.2%), assess blood and blood products sensitivity (34.1%) and control of blood tests for blood count and coagulation factors (20.5%). In the transfusion phase, slow shaking the blood bag during injection (68.6%) and venous line washing with saline solution (45%) were not according to guidelines. After the transfusion phase, the volume of infused products, blood types, post-transfusion reactions and vital signs, and status of product labeling were recorded in 100% of the nursing reports.

Implications for Practice: 

The performance of nurses was poor in many cases during the transfusion stage which can affect the health of the neonates. Therefore, it is recommended to provide continuous and persistent training for the staff.

Restless legs syndrome (RLS) is prevalent among patients undergoing hemodialysis. This research suggests that cold dialysis solution and stretching exercises are effective approaches reducing RLS; however, they should be adopted according to the patient’s condition.

This study aimed to compare cold dialysate with stretching exercises on RLS severity in patients undergoing hemodialysis.

This two-group randomized clinical trial was conducted on 44 hemodialysis patients with RLS. One group received cold dialysis (35.5°C) and the other group performed stretching exercises in two hemodialysis centers in Sabzevar, Razavi Khorasan Province, Iran, in 2019. The severity of RLS was measured in both groups using the IRLS scale at the baseline and end of each week for 6 weeks. The data were analyzed in SPSS (version 21) using repeated measures ANOVA and Friedman’s test.

The mean age of participants in cold dialysis and stretching exercise groups were 54.5±13.6 and 54.5±10.8 years, respectively. The Friedman test results showed a significant reduction in the severity of RLS in both groups (P=0.001). Moreover, the repeated measures ANOVA results revealed that the time effect was significant (P=0.001). However, group effect (P=0.09) and interaction between time and group (P=0.25) were not significantly different.

Implications for Practice:

 Both methods of cold dialysate and stretching exercises decreased RLS severity; therefore, they can be suggested to nurses as effective strategies. Due to the limited sample size, studies with larger sample sizes are recommended.

Different complications of colostomy in neonates can lead to readmission, surgery, and even death. Therefore, prevention of colostomy complications highlights the empowerments of mother to care for the neonate and reduce maternal distress.

The present study aimed to determine the effect of maternal empowerment programs on neonatal colostomy complications and maternal distress tolerance.

This randomized clinical trial was conducted on 60 mothers of newborns aged 1-90 days with colostomy referred to two specialized pediatric centers in northeastern Iran in 2019. The control group received a training session. The intervention group, in addition to one training session, participated in two sessions of maternal empowerment program regarding the care of neonates with a colostomy. The collected data were analyzed in SPSS software (version 21) using ANOVA, Friedman, and Mann-Whitney U tests.

The two groups were homogeneous considering demographic variables (P<0.05). According to the results of the Mann-Whitney U test, the skin complication in the neonates was less in the intervention group than in the control group at all three stages of assessment (P<0.001). Moreover, the repeated measures ANOVA results demonstrated that the effect of group (P=0.006), effect of time (P<0.001), and interaction of group and time (P<0.001) were significant on the total score of distress tolerance.

Implications for Practice:

 Considering the positive effect of the maternal empowerment program on reducing maternal distress and skin complications of colostomy among neonates, it is recommended to use this program in surgical wards and neonatal intensive care unit.

Neonates have limited reserves of energy. In esophageal atresia (EA) repair surgery, there were concerns about feeding initiation due to the location of the surgery.

To determine the effect of early enteral feeding on feeding tolerance and the duration of hospital stayin neonates with esophageal atresia.

In this randomized clinical trial, 48 neonates who underwent type-C esophageal atresia surgery at Dr. Sheikh (a subspecialty centers in eastern Iran), July 2015 - November 2017 were randomly divided into the intervention and control groups. In the intervention group, 48 hours after surgery, feeding was initiated once the absence of anastomotic leakage was confirmed by a chest X-ray. The control group received routine feeding from the fifth day after surgery. Feeding tolerance and length of hospital stay (LOS) were compared. Data were analyzed in SPSS-16 using Fisher's exact and Independent sample T tests.

The mean weight before intervention was 2550.1±523.4 grams in control and 2540.6±856.0 grams in intervention groups. Results revealed no significant differences between the intervention and control groups in the frequency of feeding volume tolerance (P=0.48). The mean duration of NGT feeding , time to achieve complete oral feeding and LOS were significantly lower in the intervention group (P<0.05).

Implications for Practice: 

In EA repair surgery early enteral feeding improved feeding tolerance and decreased LOS. So the approach to feeding after EA repair surgery is recommended to be reviewed, and considering patient’s condition, can be started earlier even from 48th hours after surgery.

Quarantine is one of the ways to control and prevent infectious diseases, such as Coronavirus Disease 2019 (COVID-19). Health care workers, who may have the experience of being quarantined, are among the people at risk for this disease.

This study aimed to explore the health care workers' perspective of quarantine.

This qualitative study was conducted based on a descriptive design. The data were collected through semi-structured interviews with 18 health care workers infected with COVID-19. The participants were selected through purposive sampling, and the data were analyzed by a contractual qualitative content analysis based on Graneheim and Landman’s approach. After an overview of each interview, semantic units, codes, as well as subcategories and categories were extracted through MAXQDA software (version 10) to obtain the themes.

The main theme obtained from this qualitative study was "support network decline" consisted of three categories, namely psychological concerns, job concerns, and self-imposed social isolation, accompanied by six subcategories.

Implications for Practice: 

The support network can develop lifestyle as a factor for health care workers. Therefore, the promotion of support network will exert positive impact on social life of the health care workers.

Caring for a disabled elderly person causes physical and emotional problems and social isolation for family caregivers, thereby reducing their resilience. Online social networks could provide social support and effect on resilience.

This study aimed to investigate the effect of sharing experiences in the online support group on the resilience of family caregivers of the disabled elderly.

This randomized clinical trial was conducted on 58 family caregivers of the disabled elderly in Mashhad, Iran. The participants were selected using convenience sampling and assigned to intervention and control groups using the permuted-block randomization technique. The participants in the intervention group shared their experiences of the problems faced by them due to caring for the disabled elderly for six weeks in an online support group with other caregivers. The data were collected using a demographic characteristics form, the World Health Organization Disability Assessment Schedule, and the Connor-Davidson Resilience Scale before and after the intervention. Finally, the data were analyzed in SPSS software (version 24).

The participants in the intervention group reported a significantly higher level of resilience at the end of the intervention, compared to the control group (P˂0.05).

Implications for Practice:

 The creation of an online support group for caregivers is a low-cost measure and does not require advanced clinical facilities. Furthermore, nurses can implement interventions to improve caregivers’ resilience. Moreover, an increase in resilience can improve caregiving abilities while caring for disabled elderly.

Postpartum adaptation failure can cause a mild psychological disorder in the type of postpartum blues. Various aromatherapy has been tested to treat postpartum blues. This study aimed to compare the effectiveness of aromatherapy using bergamot with lavender oils in postpartum blues. This non-randomized quasi-experimental controlled trial study with a pretest and posttest design was performed on 40 women after cesarean section (C-section) using consecutive sampling. The Edinburgh Postnatal Depression Scale (EPDS) questionnaire was used for the diagnosis of postpartum blues. The participants were given seven drops of aromatherapy oils via a handkerchief inhaled with ten deep breaths for 14 days and then placed next to a pillow. The EPDS scores were measured twice (at the baseline and after 7 days). The data were analyzed using SPSS software (version 21) and the Mann-Whitney U and Wilcoxon tests. The mean EPDS scores before the intervention were 11.4±0.9 and 11.1±1.2 in the bergamot and lavender groups, respectively. The mean EPDS scores on the 7th day of the intervention were 8.8±3.1 and 5.3±2.2 in the bergamot and lavender groups, respectively (P=0.003). Aromatherapy is recommended within the 3rd to 5th day following C-section.

We read the published papers on coronavirus disease 2019 (COVID-19) with a focus on the psychological effects of quarantine. The results of studies showed that COVID-19, which was first observed in late December 2019 in Wuhan, China, has rapidly spread. On 19 February 2020, Iran reported its first confirmed cases of infections in Qom. The disease has rapidly spread around the world, and in March 2020 the World Health Organization declared COVID-19 to be a pandemic (1). The rapid spread of the virus, along with the absence of effective medicines or vaccines against COVID-19, has prompted health policymakers in many countries to introduce quarantine policy as the most effective way to control the epidemic (2). Quarantine has been considered an important early health measure in the epidemic of diseases, especially infectious diseases in the past (3), and investigated in several studies for its negative psychological effects, such as anxiety, depression (4), and isolation. In addition, the persistence of psychological symptoms is reported after the termination of quarantine. Researchers recommend interventions, such as remote counseling, web-based training (5) and other training activities, awareness, and transparency of information by health professionals and policymakers, for the reduction of anxiety and other psychological symptoms to lessen the effects of quarantine (6). In these types of epidemics, anxiety management is one of the most important factors affecting society and practicing health interventions and guidelines (4). At the time when the corona crisis has become a public and pervasive issue and common danger to all individuals in society, although not everyone is equally affected, there is a greater sense of solidarity and no conflict of interest. In this situation, individuals try to help each other in various ways, such as providing the correct information about the condition of the disease and related issues (7) and singing at certain hours from the windows of buildings to relieve the loneliness and attention of each other (8). Studies over the past 20 years on the effects of pandemics on social cohesion can help observe the effects and best responses to COVID-19, especially in developing countries (9). Social solidarity in Iranian society has always increased in the face of adverse events, such as wars, floods, and earthquakes. Following the outbreak of the COVID-19 epidemic in Iran, popular spontaneous measures were aimed at helping in difficult epidemic conditions and leading to social cohesion in Iranian society. These measures may include renting out rentals, making jokes about COVID-19 shared on social networks leading to increased resilience, and appreciating the dedication and hard work of nurses and doctors. Various ways also include lighting candles on balconies, going home to distribute disinfectants in disadvantaged areas, disinfecting ATMs, street surfaces, and passages by volunteers, and providing needs and shopping items for the elderly and disabled. It is suggested to carry out studies on the psychological effects of quarantine with regard to issues, such as cohesion and social cohesion, cultural context, and positive dimensions of the issues. It seems that the consideration of these issues can provide valuable data for the formulation of health and even treatment policies and programs focusing on social capital (as a hidden force in the relationships between individuals in a society).  This letter to the editor was approved by Gonabad University of Medical Sciences and is listed in the Research System (no.: A-10-1813-2).