نشریه پرستاری مراقبت ویژه
سال چهاردهم شماره 3 (پیاپی 51، پاییز 1400)

The kidney disease has many psychological problems. The aim of this study was to investigate the effectiveness of acceptance and commitment therapy before dialysis, with and without mindfulness exercise during dialysis on depression and illness perception during a two-month follow-up period.

This study was a three-group clinical trial with a repeated measures method. Sixty patients were purposefully selected and were randomly located in experimental groups (First group; acceptance and commitment, second group; acceptance and commitment therapy with mindfulness exercises) and control. The research instruments included the Patient Health Questionnaire (PHQ) and the Illness Perception Questionnaire (IPQ).

Depression significantly reduced in the first and second experimental group (P<0.001). Also, in both experimental groups compared to the control group, depression decreased (P<0.05). In addition, in the first and second groups, disease perception increased (P<0.01). However, changes in disease perception in the follow-up period in the second group (P>0.05) remained stable contrary to the results of the first group (P<0.05).  The effectiveness of the intervention in the second group was significant compared to the other two groups (P<0.05).

Acceptance and commitment therapy as an effective intervention can be used in medical centers to reduce depression and its combination with mindfulness exercise is effective in improving cognitive processes of hemodialysis patients.

Health literacy as one of the effective social components in community health needs special attention. This is especially important for mothers who are responsible for caring for their premature babies. Nurses, as the front line of communication with these mothers, are obliged to recognize and select effective methods to promote health literacy in this group. The aim of this study was to determine the effect of teach-back education on the health literacy level of mothers of premature neonates in the Neonatal Intensive Care Unit (NICU).

In this quasi-experimental study, 128 mothers with premature neonates who had referred to the NICU of hospitals affiliated to the Iran University of Medical Sciences were. Mothers were nonrandomly divided into experimental and control groups. In the experimental group, the educational needs of the mother were determined through the Parent Health Literacy Activities questionnaire. Then, education to the mothers was done in a teach-back approach. In the control group, mothers received routine care. Maternal health literacy levels in both groups were assessed before and three months after discharge.

There was no significant difference between the two groups in terms of demographic characteristics (P<0.05). There was no significant difference between the two groups in terms of health literacy score before the intervention (P=0.372). However, the health literacy score was higher in the experimental group compared to control group three months after the intervention (P<0.001). In addition, there was a significant difference in the health literacy score before and three months after the intervention in the experimental group (P<0.001). In the control group, there was no significant difference in terms of the health literacy score before and three months after the intervention (P=0.059).

This study showed that teach-back education improves the health literacy of mothers with premature neonates. Therefore, it is suggested that nurses use this educational method to improve the health literacy of mothers with premature neonates during discharge.

The effects of COVID-19 not only disrupt patients' lives, but also affect caregivers. The aim of this study was to determine the effect of tele-nursing on the care burden of family caregivers of COVID-19 patients discharged from 22 Bahman Khaf Hospital.

This quasi-experimental study was performed on 120 family caregivers of COVID-19 patients from the beginning of May 2020 to the end of October 2020. Samples were selected by Convenience Sampling and were randomly divided into two equal groups (intervention and control). In the intervention group, training was performed through care load-based tele-nursing for a period of one month while no intervention was performed for the control group. Both groups completed the Zarit Care Questionnaire before and one month after the intervention.

In the experimental group, the mean score of total care pressure and its components after the intervention was significantly lower than before (p <0.001), but in the control group, the mean score of total care pressure and its components (except objective pressure before and after the intervention) was not significantly different (P> 0.05).

Tele-nursing training reduces the burden of care in family caregivers of COVID-19 patients. Therefore, it is suggested that health managers, by creating appropriate policies, put the implementation of the tele-nursing process in the family caregivers of COVID-19 patients on their agenda.

Postoperative anxiety and pain are still a common problem among intensive care patients, especially in the open-heart surgical Intensive Care Unit (ICU). Inadequate pain control can lead to increased sympathetic system activity, increased mortality and morbidity, prolonged hospital stays, and increased hospitalization costs. The aim of this study was to determine the painful and anxious procedures in the open-heart surgical ICU and its effect on hemodynamic parameters.

This cross-sectional study was conducted on 140 patients who were admitted in three open-heart surgical ICUs from two cardiac surgery hospitals in Shiraz, Iran from 2019 to 2000. Intensity of pain and anxiety were assessed using the Pain -Numerical Visual Scale (P-VNS) and the Anxiety--Numerical Visual Scale (A-VNS), before (as a baseline) and immediately after procedures, change of position, breathing exercises, change of dressing, removal of endotracheal tube, chest tube, venous line, arterial line, balloon pump catheter, and sampling were examined. The systolic and diastolic blood pressure and heart rate were recorded before and immediately after each procedure.

Comparison of the mean pain scores in breathing exercises, change of position and removal of the chest tube and the mean anxiety scores for removing the endotracheal tube before and immediately after the procedure using paired t-test showed a statistically significant difference (P<0.001). Changes in hemodynamic parameters were also significant before and immediately after removal of the endotracheal tube and balloon pump catheter, position change and respiratory exercises (P<0.001).

Respiratory exercises and removal of the endotracheal tube were the most painful and anxious procedures in the ICU. Many patients still experience moderate to severe postoperative pain in the ICU, despite guidelines that make pain control an important priority in caring for critical patients. Managing pain and anxiety before any procedure can reduce the negative consequences and increase patient satisfaction. Therefore, managing pain and anxiety in ICU requires the use of a multidisciplinary approach. In this regard, it is necessary for health care providers to consider the management of pain as an important priority in ICU patients.

The chronic and complex nature of heart failure has led to raise the need for self-care as the core of care and treatment of the patients. Health literacy and illness belief are factors may affect self-care and the way they can cope with the disease. This study was conducted to determine the association, if any, of health literacy and illness beliefs among patients with heart failure.

This study is a descriptive-correlational performed on 133 patients with heart failure hospitalized in Cardiac Care Unit in Karaj. They were selected by the convenience sampling method. Data collection method included a demographic questionnaire, the Iranian Health Literacy Questionnaire (Montazeri 2013) and the illness belief (Albert 2007) in heart failure.

The total mean score of the health literacy was 73.01 (±13.08) and the total mean score of the correct belief illness was 3.07 (±0.45). There was no significant association of health literacy with illness belief (r=0.130 and P=0.137).

More than a quarter of the patients had inadequate health literacy, and more than 40 percent had incorrect beliefs about heart failure. Therefore, to improve health behaviors, it is necessary not only to promote health literacy, but also to consider incorrect illness beliefs.

Pain management is very important in patients in general intensive care units (G-ICU). Therefore, this study was conduct to investigate the validity and reliability of the Persian version of Critical Care Pain Observation Tool in patients admitted to this ward.

The present study is a methodological and clinimetery study that was conduct in inpatients in general intensive care units of Amol city during 2009-2010. The accordance between the two assessors was investigated using Lin’s Concordance correlation coefficient and the weighted kappa coefficient. The researcher evaluated Sixty-six patients in two positions of resting and painful action, using discriminant validity and the intended tool, to measure the validity of the tool.

The results showed the validity of the instrument through the validity of known groups, the score difference in the three indices of tool were meaningful (P<0.001). Also, the difference between the overall mean scores in the two positions of resting and rotation was meaningful, as well (P<0.001).  Reliability of the instrument through weighted kappa coefficient for quartet indices of the tool in the two resting and change position status varied between 0.38 and 0.60. The accordance between the two assessors in the overall score of the tool using Lin’s Concordance correlation coefficient was 0.68 in the resting position, 0.82 -0.47 in assurance interval, 0.67 in the rotation position in assurance interval, and 0.42 to 0.82 in assurance interval.

Although the Persian version of the CPOT could differentiate pain-causing situations from no pain-causing ones, but its rate was low. Besides, the accordance between the two assessors was weak to medium. Therefore, it is recommended to use it with more care and caution in different patients with different diagnoses; also, other criteria for pain in patients should not be ignored.

Ventilator-associated pneumonia is a serious nosocomial infection that can increase the length of stay, prolong the use of mechanical ventilation, and increase the risk of death in patients in the critical care unit. The aim of this study was to evaluate the knowledge of Iranian critical care nurses toward the prevention of ventilator-associated pneumonia in a systematic review.

In this systematic review, an extensive search of databases, such as PubMed, Web of Science, Scopus, Iranmedex, Magiran, SID and Google Scholar search engine using Persian and English keywords related to the aim of the study, was conducted from the earliest to October 17, 2020.

In total, 8 articles from 1822 studies, with 887 nurses and a mean age of 31.80±5.87 years, and work experiences of 62.04±39.48 months in critical care units, were included in this study. In six studies, the level of knowledge of nurses was insufficient. The lowest and highest levels of knowledge were related to the dimensions of "suction through tracheal tube/tracheostomy and drainage of subglottic secretions" and "selection of the appropriate patient position", respectively. In two studies, a direct relationship was reported between nurses' level of knowledge and work experience. In one study, older age was directly related to the mean score of nurses' knowledges.

The knowledge of Iranian critical care nurses toward the prevention of ventilator-associated pneumonia was insufficient. Therefore, it is suggested that researchers implement appropriate interventions in nurses to improve their knowledge toward prevention of ventilator-associated pneumonia, in future studies.