نشریه پرستاری مراقبت ویژه
سال سوم شماره 2 (پیاپی 7، تابستان 1389)

Restoring the vital functions of heart and lung and the efforts to establish circulation and respiration are among the most important measures of professional resuscitators in health centers. The aim of this study was to investigate the rate of survival and the outcomes of cardio pulmonary resuscitation in educational hospitals of Tehran. This cross-sectional longitudinal study was conducted during 5 months; in 3 educational and university selected hospitals on 250 patients underwent cardiopulmonary resuscitation procedure. Data were collected with standard form of recording resuscitation cases in hospital (Utstein) including various variables such as age, sex, working shift, location of arrest, cause of arrest, initial cardiac rhythm, short and long term resuscitation outcomes. Data were analyzed with SPSS 14 statistical software and descriptive and inferential statistical tests (Chi-square and logistic regression). 59.6% of participants were male and the average age of total sample was 57.17±21.10 years old. 64.4% of CPR attempt was unsuccessful and were led to patients’ death. 28.4% of cases were successful in Short-term. Only 7.2% of studied cases had long-term survival after resuscitation procedure and were discharged from hospital. More attention to the chain of survival and causes of success and failure of cardiopulmonary resuscitation and addressing the predictors of the success of cardiopulmonary resuscitation seem necessary.

The frequency of severe burn and the results of this injury in the form of death, mortality, illness and social and economical costs on society is an acceptable justification for special attention to the burn victims by health experts. This study was conducted to investigate the effect of jaw relaxation on dressing pain intensity of burn patients.

This study was a randomized clinical trial. One hundred patients referred to Shahid Motahari Burn Center in Tehran within July to December, 2009 were selected by convenience sampling and were randomly assigned to either experimental or control groups using minimization method. The experimental group practiced jaw relaxation technique for 20 minutes before entering dressing room. Data were collected using Visual Analogue Scale (VAS) and analyzed by SPSS 17 and independent t-test.

The mean burn dressing’ pain intensity score in experimental group was 45.93±24.97 and in control group was 48.05±25.61.There were no significant difference between the pain intensity after dressing in both experimental and control groups (p=0.676).

Regarding to ineffectiveness of jaw relaxation on burn dressing’s pain intensity, it is suggested that further relaxation practice sessions be held and continued in the dressing room and also the effect of this technique on residual, penetrating and procedural pain of burn patients be examined and compared.

Medical emergency students are subjected to the risk of occupational exposure to blood-borne viruses following needle stick/sharp object injuries (NSIs/Sis) and blood / body fluids exposures. The goal of this study was to determine the frequency and the features of contaminated NSIs/Sis and blood/body fluids exposures among emergency medical technicians students.

This descriptive cross-sectional study was conducted in Arak University of Medical Sciences in 2009. 52 medical emergency students were participated in the study. Data collection tool was a bipartite researcher-made questionnaire. The first part was related to individual characteristics and demography and the second part was related to the frequency and causes of needle stick/sharp object injuries contaminated with blood and blood / body fluids exposures and the performance of students during injury incidence.

32.7% and 13.46% of the subjects had experienced at least one contaminated NSI and blood / body fluids exposures in the last term, respectively. Only 41/17 % and 16/66 % of the students who had experienced NSIs and blood / body fluids reported all exposures, respectively. The most common procedure leading to these injuries was catheter insertion. The first measure taken by the most students following the injury was washing the injury location.

The amount of NSIs and blood/body fluids exposure is high among medical emergency students and also the performance of some of them after incidence is not appropriate. More education programs should be planned and performed for medical emergency students in order to increase their awareness about prevention from these injuries and their resulting hazards and the subsequent actions and measures.

Since there are disagreements about the relationship between the duration of hospitalization and complications outbreak and the causes of mortality, this study was conducted to investigate the epidemiology of causes of hospitalization, complications and mortality of the hospitalized patients in the intensive care unit (ICU) of Central province’s hospitals. In this descriptive cross sectional study, 981 patients who were admitted in the Central provinces’ ICUs in 2008 were selected as the participants of the study. The patients’ neurologic, respiratory, hemodynamic conditions, vital signs and physical injuries were analyzed and recorded in the check list. At the time of patients’ release or death, the final analysis was done in terms of the symptoms and signs of the disease. Data were analyzed using SPSS 11 statistical software and logistic regression, probability ratio and chi square tests. The most common cause of death was a cardiac arrhythmia (28. 1%). The most prevalent cause of hospitalization was accident (12.6%) and coma (12.1%). The dominant complication among the respiratory complications was infection in all ICUs. The average hospitalization duration of studied patients was 7 days. Accident and heart diseases were the most common causes of death in ICU.

Improving the adequacy of dialysis is the main factor for reducing complications and mortality in dialysis patients. According to different researches, music affects physiologic factors. But there is not any research that reveals the effect of music on dialysis adequacy. This study was conducted to compare the effect of the voice of the Koran with normal sound, silent, Arabic and Iranian music on adequacy of dialysis. This clinical trial study was conducted by participation of all chronic renal failure final phase patients admitted in haemodialysis ward of Jahrom’s Motahari hospital in 2008. 68 patients were selected by purposive or goal-oriented method. Data were collected using Glak & Stark religious measuring questionnaire. Interventions were done in 5 stages. Normal situation, lilt or rhythmic voice of Koran (Yasin: 1-83), Iranian music (30 minute), Arabic music (30 minute) and silent situation. All variables affecting adequacy of dialysis in all intervention sessions were homogenized. Dialysis adequacy was compute by kt/v formula. Data were analyzed using Chi square, Paired T test and ANOVA test. Means of dialysis adequacy calculated by 0.963 ± 0.757 kt/v, 51.6 ± 87.9 URR and 0.484 ± 0.121 PRU formulas. No significant difference was observed in 5 groups by ANOVA test (p>0.05). Normal situation had the best dialysis adequacy. No one of the situations had impact on dialysis adequacy; although the calculated adequacy by kt/v formula in the Koran sound-using situation shows an improvement increase which is not significant.

Religious beliefs are important factor in mental supporting of patients. In order to feel more comfort and gain a new power to move toward more accommodation with disease, one should rely on the power of God. Religious practices, prayer and benediction not only affect emotional states of individual but also his physical quality and sometimes within a few moments or a few days improve the physical illness. This study was conducted to evaluate the rate of resorting to God in hemodialysis patients. In this single-group single-phase descriptive cross-sectional study, 245 dialysis patients referred to the hemodialysis center of Golestan province were selected based on purposive or goal-oriented sampling method. Information was collected through prayer Meraviglia frequency questionnaire. Data were analyzed using SPSS16 and Friedman test and descriptive statistics The rate of resorting to prayer was 173.9 ± 9.8%. 98.4% of subjects used prayer in a high level. The score of prayer frequency was 6.6 ± 95.2, previous experience pray was 64.9 ± 4.6 and the attitude of prayer was 31.8 ± 3.1. With respect to prayer frequency 44.5% of subjects constantly thanked God for his favor and 42% were also continuously demanded the help of Allah. Regarding previous prayer experience, 88% of patients in the past believed that “sometimes, God heals patients”. With regard to attitude, 40% of subjects agreed that God took care of them. Significant relationship between prays’ aspects was observed (p<0.01). Resorting to prayer in hemodialysis patients is at a high level.

The respiratory-digestive mechanism colonization and aspiration of contaminated secretions to the lower respiratory tract are two main processes in creating pneumonia associating with artificial ventilation. This study was conducted to determine the effect of chlorhexidine gluconate 0.2% oral rinse in preventing from pneumonia associated with delayed artificial ventilation and its interactive effect with disease severity. In this clinical trial study, 80 patients newly admitted in the general intensive care unit (ICU) of Loqman-e-Hakim hospital were selected randomly and assigned in two groups. Patients of experimental and control groups received daily twice chlorhexidine oral rinse and normal saline oral rinse, respectively. Ventilator associated pneumonia was diagnosed by Modified Clinical Pulmonary Infection Score (MCPIS). The overall incidence of late VAP was 16.25% (5 VS 25% in experimental and control groups, respectively). Fisher’s exact test showed a significant differences between two groups (p<0.05). Average score of illness severity in chlorhexidine group was 26.41 while in normal saline group was 23.95 that implied a significant statistical difference (p<0.001). Patients with higher severity of illness didn’t develop VAP in chlorhexidine group. Selective decontamination or cleaning of digestive tract with chlorhexidine oral rinse twice a day does not differ from normal saline in prevention of ventilator associated pneumonia, but can reduce the late onset of ventilator associated pneumonia and is effective in patients with more severe condition.

According to Orem’s definition, self care involves those learned behaviors that individuals perform in order to preserve or promote their life, health, well being and prevention or treatment of their disease. Self care can play an effective role in the management of individuals with chronic diseases including coronary artery disease. The aim of this study was to determine the self-care ability and the relationship between self-care ability and some variables in individuals with coronary artery disease. In this analytical- descriptive study, 307 individuals, 40 or older with coronary artery disease, referred to the military 502 hospital of Tehran between July and November in 2009, were selected through a goal-oriented or purposive sampling method. The data was collected through an interview by using the “self-care ability practice” and a “basic conditioning factors “questionnaire. Data were analyzed using SPSS 14 software and descriptive statistical methods and one-way ANOVA. The self- care ability mean was 59.13 ±12.62. Factors including sex, age, occupation, education and income level had not a significant relationship with self-care ability (p>0.05). Self-care ability of individuals with arterial coronary disorders is in moderate level and self-care ability and health are not affected by basic conditioning factors (socio demographic).