Evidence Based Care
Volume:12 Issue: 4, Winter 2022

Fatigue and pain are of the most common symptoms in dialysis patients affecting their quality of life (QoL). One of the methods to reduce pain and fatigue is the use of complementary therapies.

This study was performed aimed to determine the impact of progressive muscle relaxation on fatigue, pain and QoL of dialysis patients.

This clinical trial study was performed on 60 patients undergoing dialysis in Zahedan, Iran, 2021. The subjects were randomly assigned to the intervention and control groups (n=30 in each group). Data collection tools included a demographic form, Fatigue Severity Scale (FSS), pain visual scale, dialysis quality of life questionnaire (KDQOL-SF), and a self-control checklist. In the intervention group, a progressive muscular relaxation was done in three training sessions for an hour by the researcher. The intervention group was asked to perform relaxation technique at home twice a day for 12 weeks. The control group received no intervention. Data were analyzed by SPSS (version 21). P<0.05 was considered statistically significant.

The mean scores of fatigue, pain, QoL and its dimensions showed no significant difference between the two groups before the intervention (P>0.05). However, three months after progressive muscle relaxation technique, the two groups were significantly different in terms of the mean scores of fatigue, pain, and QoL (P<0.05).

Implications for Practice: 

The implementation of the relaxation technique reduces fatigue and pain and develops QoL of dialysis patients. Progressive muscle relaxation technique is recommended to be used as an intervention in nursing care.

Although ethical practice is critical in anesthesiology, few practical measures have been presented to implement ethical clinical practice to this specialty.

This study was performed aimed to identify Iranian anesthesiologists' perceptions of moral distress in caring of anesthetized patients.

This qualitative study was performed using conventional content analysis approach based on semi-structured interviews of 15 anesthesiologists which worked in the hospitals affiliated to Tehran University of Medical Sciences in 2019. The sampling method was purposive and the data were analyzed based on Granheim and Landmann method.

Ethical distress perceived by anesthesiologists was classified into the following eight categories: (i) Ethical distress regarding informed consent and respect for patient autonomy, (ii) Ethical distress regarding the cancellation or postponement of patient's surgery, (iii) Ethical distress regarding the anesthesiologist's relationship with patients undergoing surgery, (iv) Ethical distress regarding surgical patients' companions, (v) Ethical distress regarding patients' privacy and confidentiality, (vi) Ethical distress regarding surgeon's colleagues and other OR colleagues, (vii) Ethical distress regarding end-of-life patients, and (ix) Ethical distress regarding fair distribution of resources and equipment.

Implications for Practice: 

The findings of the present study can provide a better understanding of situations that cause moral distress for anesthesiologists and can be used in policy making and preparing ethical codes and ethical guidelines for working in the operating room. Identifying ethical distresses of anesthesiologists in the hospital is the first step in conducting managerial interventions to improve the state of clinical ethics and organizational ethics in a care provider setting.

Acute Myocardial Infarction (AMI) patients generally report persistent symptoms such as pain, fatigue, depression, and disorders in fulfilling daily needs. Physical activity has a beneficial effect on cardiopulmonary rehabilitation and remodeling of dysfunction after AMI.

This study was performed aimed to identify physical activity and related factors in AMI patients.

This cross-sectional study was performed on 150 post-treatment AMI patients who were discharged from a central hospital in Indonesia from February to March 2019. The physical activity data were collected using the International Physical Activity Questionnaire. Depression was measured using the PHQ-9 Patient Depression Questionnaire, and self-efficacy using the Cardiac Self-Efficacy Scale. Data were analyzed by SPSS software (version 26.0) and Chi-square and fisher’s exact tests. P<0.05 was considered statistically significant.

After hospitalization, majority of patients were in adult age (<60 years old) category (73.3%), were male (78.8%), had passed 7 to 30 days post-discharge (75.3%), and had comorbidities (64.7%). The majority of patients had mild physical activity (82%), in the mild depression category (69.3%), and had negative self-efficacy (86.7%). Factors related to low physical activity were age (P=0.002), gender (P=0.0001), days after hospitalization (P=0.03), comorbidities (P=0.02), depression (P=0.003), and self-efficacy (P=0.0001). The logistic regression test showed that age, gender, and self-efficacy improve physical activity in post-discharge AMI patients.

Implications for Practice: 

Age, gender, and self-efficacy can enhance physical activity in post-discharge AMI patients. It is suggested that a pre-discharge and follow-up education be performed to evaluate physical activity.

Most patients with traumatic brain injury (TBI) admitted to the intensive care unit experience pain. Nurses have a major role in pain management in patients with TBI.

This study was performed aimed to investigate the effect of white noise on pain in unconscious patients with TBI.

This single-blind clinical trial study was performed in 2019 on 52 unconscious patients with TBI admitted in neurological intensive care unit in Ardabil. They were randomly assigned to the control and intervention groups. In the intervention group, patients received 30 minutes white noise for 3 consecutive days. In the control group, patients rested only on the bed at the same time. The demographic characteristics form and behavioral pain scale were used to collect data. P<0.05 was considered statistically significant.

The mean difference of behavioral pain score during three consecutive days 10 minutes before and 30 minutes after the intervention was 0.82 ± 0.1 in the intervention group and 0.18 ± 0.01 in the control group. Data analysis showed that the behavioral pain score in the intervention group significantly reduced compared to the control group (P <0.001).

Implications for Practice: 

The results of this study showed that white noise could relieve the behavioral score of pain in unconscious patients with TBI. Therefore, it is recommended to use white music noise along with routine treatments to reduce the pain of unconscious patients with traumatic brain injury in the neurological intensive care unit.

Surgical anxiety and pain are common complaints of hospitalized children, which can have devastating effects on the child's recovery process.

The present study was performed aimed to investigate the effect of one session of eye movement desensitization and reprocessing (EMDR) on anxiety and pain of hospitalized children after appendectomy.

This clinical trial study was performed on 46 children hospitalized in the hospital affiliated to Isfahan University of Medical Sciences from December 2019 to February 2020. The subjects aged 12 to 16 years who underwent appendectomy and were randomly placed in two groups. The trait anxiety and demographic characteristics were assessed before the surgery. Six hours after the surgery, the intervention group received one session of EMDR along with the routine treatment, and the control group only received the routine treatment. State anxiety and pain were assessed in the two groups before, immediately and one hour after the intervention. P<0.05 was considered statistically significant.

The state anxiety level after appendectomy was high in both control (50.87±12.45) and intervention (53.15±6.36) groups; however, the difference was not significant (p=0.654). Also, the mean of pain in the intervention and control groups before the intervention was not significantly different (p=0.948). But the level of state anxiety and pain immediately and one hour after the intervention showed a significant difference in the intervention and control groups (p<0.05).

Implications for Practice: 

The results of this study showed that EMDR can be effective in alleviating anxiety and pain after surgical procedures in hospitalized children.

Clinical failures are considered as a serious problem in the health system and a threat for patients’ safety. The nurses' performance was poor during the blood products transfusion for children. One of the main obstacles to implement a national blood policy in developing countries is the lack of trained staff.

To determine the effect of a designed training program based on the ADDIE model (analysis, design, development, implementation, evaluation) on nurses’ performance regarding  blood transfusion for children.

This randomized clinical trial (RCT) study was performed  in Bint Al-Huda teaching hospital at Al- Nasiriya City in Iraq. The study started from July 2021 to March 2021 and involved 60 nurses. Data was collected using a demographic data questionnaire and the observational checklist of  nurses’ performance regarding transfusion of blood and blood products. At first, nurses’ performance regarding transfusion of blood and blood products to a child was checked. Then, the intervention group received a designed training program based on the ADDIE model. Again, nurses’ performance was assessed. Finally, data were analyzed with SPSS 25 software. P<0.05 was considered statistically significant.  

The scores of nurses’ performance in pretest stage in the intervention and control groups was relatively similar (M=10.23±1.07 versus M=10.83±4.49; P>0.05), but in post-test stage, the scores of the intervention group were higher (M=36.40±3.08 versus M=10.85±4.53; P<0.001).

Implications for Practice: 

According to the results, the designed training program based on ADDIE model can be used in pediatric setting to improve the nurses’ knowledge and practices about blood transfusion.

Nurses are a vital element of the health care delivery system, and their shortage has a negative effect on the quality of patient care.

This study was performed aimed to investigate nurses' intention to leave the profession (ITL) and its related factors.

This cross-sectional study was performed on 265 nurses working in the teaching hospitals of Zanjan University of Medical Sciences, Iran, from September 2020 to February 2021. Data was collected using demographic and researcher-made ITL questionnaires. Data were analyzed by SPSS (version 16). P<0.05 was considered statistically significant.  

Among the 265 nurses surveyed, 154 (58.55%) intended to leave the profession. The total score of intention to leave the profession was 60.21±14.46. From the perspective of nurses, "lack of welfare facilities," "high workload," "high working hours," "lack of proper management processes," and "low income" have higher priority for the intention to leave the profession. There was a statistically significant relationship between the type of shift work (p<0.05) and the amount of income (P<0.001) with intention to leave the profession. Age, gender, and income were identified as the predictors of the nurses' intention to leave the profession (P<0.05). 

Implications for Practice:

 The intention to leave the profession is alarmingly high among Iranian nurses. Managers and policymakers can consider the factors identified in this study to diminish the nurses' intention to leave the profession.

Hospitalization in the coronary care unit causes psychological stress for the patient's family members. Education and support of these families may control depression, anxiety and stress and increase their satisfaction.

This study was performed with aim to determine the effect of the supportive educational program on depression, anxiety and stress and satisfaction of the families of patients admitted to the coronary care unit. 

This randomized clinical trial study was performed in 2019 on 70 families of patients with acute coronary syndrome hospitalized in the coronary care unit of Imam Reza and Ghaem hospitals in Mashhad. Patients' families were randomly assigned to the intervention and control groups by time block method. In the intervention group, the supportive educational program was implemented for three days and the control group received routine care. Depression, anxiety and stress scale (DASS) was completed in both groups before and after the intervention, and the questionnaire of the Family Satisfaction with Care in the Intensive Care Unit (FS-ICU) was also completed after the intervention. Data were analyzed by SPSS (version 16).

After the intervention, the mean total score of depression, anxiety and stress of the patients' families in the intervention group was significantly lower than the control group (P<0.001). Also, the total score of depression, anxiety and stress after the intervention was reduced compared to before the intervention in the intervention group and also in the control group (P<0.001). Also, the mean satisfaction score of patients' families in the intervention group was significantly higher than the control group (P<0.001).

Implications for Practice:

 Based on the findings of this research, the supportive educational program reduced depression, anxiety and stress in the families of patients with acute coronary syndrome hospitalized in the coronary care unit and increased their satisfaction.