Evidence Based Care
Volume:14 Issue: 1, Spring 2024

Heart failure is a potentially life-threatening condition that disrupts the normal flow of blood throughout the body. Patients with heart failure lack sufficient knowledge regarding drug treatment adherence. An effective discharge plan and its continuity can improve treatment adherence.

This study was performed with aim to compare two methods of discharge care program follow-up on drug treatment adherence of patients with heart failure.

This quasi-experimental was conducted in 2022-2023 on 126 patients with heart failure in Iran. Participants were divided into the two intervention groups via telephone call (group A), and via video message (group B) and a control group (group C). The required data were collected through Morisky Medication Adherence Scale (MMAS-8) before and 12 weeks after the start of the intervention. In the intervention groups, the care plan was presented to the patients every two weeks.

The mean drug treatment adherence scores increased to 2.47±1.68 in group A, 1.51±2.11 in group B, and 0.83±1.60 in group C,  which was significantly different in each group and among the three groups (p<0.001). The Mean changes in the patient’s drug treatment adherence in group A were statistically significant only compared to group C (p<0.001). After adjusting confounding variables (age, gender and cause of heart failure), there was a significant difference among the three groups in the patient’s drug treatment adherence and quality of life (p=0.002).

Implications for Practice: 

According to the obtained results, the nurses are recommended to continue the care program after discharge and use technologies to improve treatment adherence.

There is a growing interest on the study and improvement of health-related quality of life (HRQOL). Type 1 diabetes can severely affect HRQOL. Iraqi adolescents with type 1 diabetes mellitus (T1DM) have lower quality of life (QOL) compared to their healthy peers.

The present study was performed with aim to assess the effect of an empowerment program on the HRQOL of type 1 diabetes adolescents.

This clinical trial study was performed on162 adolescents with T1DM referred to the Al-Hassan Diabetes Center of Karbala/Iraq in 2021-2022. Firstly, the adolescents’ Empowerment Package was compiled. Then sampling was taken via simple randomization method. The Kidscreen Questionnaire was used for data collection. The implementation of the empowerment program began for the intervention group in the groups of 10 to 15 people and in 10 sessions, three sessions per week. The control group received the routine care. Four weeks after completion of the intervention, the QOL score was again measured and compared in the two groups.

Before the intervention, there was no significant difference between the Kidscreen scores of the control (88.70±10.80) and intervention (87.89±9.50) groups (p=0.62), but this difference was significant in the post-intervention stage (82.90±8.00 vs 89.70±8.80) (p<0.001). In the inter-group comparison, paired t-test showed a significant difference in Kidscreen score before and after the intervention in the intervention group (p<0.001) and in the control group (p<0.001).

Implications for Practice: 

We could suggest empowerment in diabetes self-care as a way to increase the QOL of adolescents with type 1 diabetes.

Pressure ulcer is a common problem in ICUs and its prevention is one of nurses’ duties.

The present study was performed with aim to evaluate the effectiveness of preventive nursing care based on Braden’s scale on the incidence of pressure ulcer in ICU patients.

This clinical trial study was performed on 72 patients admitted to the ICUs of Golestan and Imam Khomeini hospitals of Ahvaz in 2020. The preventive care based on Braden scale was performed for 6 days in the intervention group. Routine care was provided for the control group. The rate and duration of pressure sores were measured based on Braden scale at the beginning of the study, every 48 for 3 times for the intervention group. The data was collected by demographic information questionnaire, Braden scale, and Pressure Ulcer Scale for Healing (PUSH).

The pressure ulcers occurred less in the intervention group (2.8%) than in the control group (8.3%), but this difference was significant (p=0.614). There was a significant difference between the two groups in terms of Braden's subscales during the intervention period (first, second and third 48 hours) (p<0.05). Preventive care increased the length of time required for the occurrence of pressure ulcers in the test group.

Implications for Practice:

 The results showed that the intervention based on the Braden scale reduces pressure ulcers, therefore it is recommended that nurses carry out care interventions based on the Braden scale to improve the quality of care and prevent pressure ulcers among ICU patients.

Hope is an important source of human coping when facing problems. Cancer is a common disease which can cause great physical and mental stress for patients, but if the diagnosis is delivered correctly, it can reduce anxiety and confusion for the patient and improve outcomes for both the patient and healthcare staff.

The present study was performed with aim to determine the impact of implementing a truth-telling protocol on life expectancy of patients with gastrointestinal cancer.

This randomized clinical trial study with a controlled pre-test post-test design was conducted at Mashhad Ghaem Hospital and Pazh Clinic in 2020-2021. Sixty patients with gastrointestinal cancer were divided into two groups: intervention group who received information about their diagnosis using the "truth-telling" protocol, and control group who received standard hospital disclosure of diagnosis. Miller's life expectancy questionnaire was used to collect data before and one month after the intervention.

One month after the intervention, the mean of life expectancy score in the intervention group was 191.56±25.56 and in the control group was 176.93±32.98. The difference between before and after the intervention in the intervention group was -4.41+12.60 and in the control group was -23.02+18.60. There was a significant difference in the mean difference life expectancy score of patients in the control group (p<0.001), but no significant difference was found in intervention group in this regard (p=0.060).

Implications for Practice: 

The "Truth-Telling" protocol did not lower the life expectancy score in patients with gastrointestinal cancer, so it is recommended to inform the patients about their disease.

Surgical site infection is an irreversible complication of spine surgery. Postoperative care instructions are of utmost significance and can decrease surgical complications, including surgical site infection.

The present study was performed with aim to evaluate the impact of the continuous care model on surgical site infection in patients undergoing spine surgery.

This quasi-experimental study was conducted on seventy spine surgery patients referred to a teaching hospital in Tehran, Iran. The sampling process lasted from June 1 until November 30, 2022.The patients were assigned into two equal groups. The intervention involved education to patients undergoing spine surgery from admission until four weeks post-discharge based on a four-stage continuous care model. Bluebelle Wound Healing Questionnaire (BWHQ) was completed in both groups four weeks after discharge.

Despite the non-significant statistical difference in demographic and clinical information between the two groups, the mean total score of post-intervention infection was 9.37±5.93 in the control group and 2.65±1.43 in the intervention group. This finding indicates a significant reduction in surgical site infection in the intervention group compared to the control group (p<0.001).

Implications for Practice:

 This study suggests that patient education based on the continuous care model following spine surgery is effective in decreasing surgical complications, specifically surgical site infection in these patients. Thus, the design and implementation of such postoperative care models are recommended for patients undergoing spine surgery.

Suctioning has been to date documented as one of the most painful and anxiety-inducing experiences among mechanically ventilated patients admitted to intensive care units.

The present study was conducted with aim to investigate the impact of foot reflexology, as a non-pharmacological method, on suctioning-induced anxiety in ICU patients receiving mechanical ventilation.

This randomized controlled trial study was conducted on 36 mechanically ventilated patients in the ICU of a military hospital in Tehran, Iran, in 2021. The subjects were randomized into either the intervention group (foot reflexology) or the control group (routine care). After the completion of the suctioning procedure, the foot reflexology technique was applied for 20 minutes on reflex points of the heart and lungs (the anterior third of the sole of the foot) in the intervention group patients. Levels of anxiety were assessed using the Faces Anxiety Scale (FAS) before and after the intervention.

No statistically significant difference was found between the two groups in demographic characteristics and anxiety levels at the pre-intervention stage. However, anxiety was significantly reduced after foot reflexology treatment in the intervention group compared to the controls (p<0.001). Additionally, anxiety levels significantly decreased in the intervention group after the intervention compared to before the intervention (p<0.001), while increased in the control group (p=0.001).

Implications for Practice: 

The results of the present study showed that foot reflexology is effective in reducing suctioning-induced in ICU patients receiving mechanical ventilation. Therefore, it is recommended to use this non-pharmacological approach at the patient's bedside.

Failure to fulfill the physical and psychological needs of breast cancer patients and their partners can result in anxiety, depression, and marital problems.

The present study was performed with aim to elucidate the experiences of breast cancer women regarding partner's unsupportive behaviors.

This qualitative study was conducted with a Dickelman descriptive phenomenological approach in the chemotherapy and oncology department of Shahid Ghazi Tabatabai and Shahid Madani hospitals of Tabriz city in 2021. A total of 9 female breast cancer patients were included. Individual in-depth interviews and note-taking were used to collect data using MAXQDA Software. The semi-structured interviews were used to collect data. Interviews were analyzed using the Dickelman, Allen, and Turner method.

A total of 1500 primary codes were obtained, and finally 3 main categories were extracted including financial inadequacy, emotional impoverishment and breakdown of shared life, and existential devaluation as a woman.

Implications for Practice:

 The results showed need for the husband to pay more attention to the impact of his behavior on his wife; also talking about the problem on the part of the couple is the biggest factor in understanding the support that can be expressed. Also, men and women do not think the same in understanding the needs of their sick partner. Male caregivers are usually less understanding of their spouses. Therefore, health professionals should pay more attention and help men cope with this problem and bear the suffering of their wives.

One of the most common preventive methods of Surgical Site Infection (SSI) is preoperative skin preparation. Selecting the skin antiseptic before surgery is an important step that can reduce SSI risk.

The present study was performed with aim to compare the effect of 7.5% povidone-iodine (PVP-I) and 70% alcohol versus 0.2% chlorhexidine (CHG) and 70% alcohol on the microbial count of the surgical site in the abdominal surgery.

This double-blind randomized clinical trial study was conducted between March 2017 and July 2018 at the educational-therapeutic centers of Iran University of Medical Sciences. The patients aged ≥18 years who underwent elective abdominal surgery were randomly assigned into two groups to have their skin cleaned before surgery with CHG-alcohol or PVP-I-alcohol. Also, before skin prep, after the primary prep and after the secondary prep, microbial cultures were taken. Data analysis was performed using SPSS (version 16) and Chi-square, Fisher's exact, Kolmogorov-Smirnov, Wilcoxon and U-Mann-Whitney tests. P<0.05 was considered statistically significant.

The microbial counts mean differences before and after skin preparation with PVP-I-alcohol were significant (P<0.05). Also, the microbial counts mean differences before and after skin preparation with CHG-alcohol were significant (P<0.05). Overall, both antiseptic groups significantly reduced microbial counts. Although the skin preparation with CHG-alcohol was better than the PVP-I-alcohol solution, the difference between the two groups was not significant (P>0.05).

Implications for Practice: 

This study did not demonstrate an overall superiority of 2% CHG over 7.5% PVP-I skin preparation solution or vice versa. Both groups can be used to prepare patients' skin before abdominal surgery due to the affordability conditions and availability.