نشریه پرستاری مراقبت ویژه
سال سوم شماره 4 (پیاپی 9، زمستان 1389)

To encounter with problems due to the disease and treatment, chronic renal failure (CRF) patients use advocacy various resources for adjustment. A few studies and cognition exist about this problem, especially in our society hemodialysis patients. This study was performed to explain perspective of CRF patients from advocacy resources in adjustment with hemodialysis. This study was conducted with qualitative research approach and content analysis method. The participants were 16 hemodialysis patients in hemodialysis ward of Semnan University of Medical Sciences hospitals. Purposive sampling began and continued up to data saturation. Unstructured interview was the main method for data collection. The data were analyzed using qualitative content analysis method and constant comparative method. In content analysis process, finally 6 themes emerged that indicated nature and dimensions of patients’ perspective from advocacy resources. These themes included 1.joining the family members, 2.informed trust and hopefulness to physician, 3.nurses’ empathy and responsible accountability, 4.to be encouraged with adjusted and transplanted patients, 5.feeling worthy with friends’ companionship, 6.assurance and satisfaction with advocacy organizations. These results can help the managers and planners of health field to facilitate the adjustment of the new patients so that in what fields and aims they must focus and plan.

Improving critical thinking is one of the most important objectives in nursing education. This study was designed to investigate the effect of concept mapping on critical thinking skills of the nursing students.

This was a quasi-experimental study with two groups, and pre-test post-test design. Sixty six 5th semester nursing students were selected through census method and randomly divided into two intervention and control groups. Control and intervention groups received education using lecture method and concept mapping, respectively, for 8 sessions during 2 months. The statistical analysis was done by software SPSS version 15. Descriptive statistics, independent t-test, chi-square and ANOVA were used in this study.

Performing concept mapping led to a significant increase in critical thinking skills scores in all the subscales except analysis scale (P = 0.286) and deductive reasoning scale (P = 0.104) in the intervention group in comparison with the control group. In spite of the significant increase in the mean score of critical thinking of the intervention group, comparing the mean difference of pre and post tests in the two groups, only analysis domain showed no significant difference.

Using concept mapping in the education of nursing students may lead to develop critical thinking skills as one of the important duties of higher education.

Lack of pain relief in patients, particularly in patients undergoing artery transplant surgery, cause higher mortality and complications. This study aimed to identify the opinions of the nurses about barriers of using pharmacological and non-pharmacological methods in pain relief methods. This was a descriptive study on 211 subjects aimed to determine comments of nursing staff of surgical wards about barriers of using pain relief methods after the surgery in Kerman Hospitals. For collecting the data, a researcher made questionnaire was used which had two parts (the first part was about demographic characteristics and the second part included 31 questions about barriers in four domains: institution, physician, nurse, patient). Analyzing the data was done by non-parametric tests (Mann-Whitney and Kruskal Wallis). In nurses’ view, most obstacles mentioned in patient’s area were not considered the barrier, and the high percentage nurses in nurse’s area were selected very effective option or moderate impact. The most effective in the organizational area was hard prevent regulations in the use of opium drugs (52.2 percent) and in the physician area, lack of physician willingness to use of pain relief methods was charged the highest barrier (91.7 percent). Results on education showed that in the patient and organizational area no difference was observed between two groups and in area related to the doctor only in a prescribed routine pain medication were showed significant differences between groups. In this case healthcare workers knew this obstacle more effective than nurses. In area related to the nurse about the time-consuming of non-drug pain relief methods was observed significant difference between groups. Nurses knew this obstacle more effective than healthcare workers. Identifying pain relief barriers would help in overcoming these barriers and besides revising the difficult regulations on the use of narcotic drugs, seems necessary.

In patients with chronic heart failure, balance abnormalities of the serum sodium and potassium levels and renal dysfunction commonly occurs. This study aimed to determine the amount of electrolyte abnormalities and renal dysfunction in elderly patients with systolic heart failure. This was a descriptive-analytical study. The study population included all the hospitalized patients who diagnosed with heart failure. A hundred and fifty four patients who had the inclusion criteria were selected using census sampling method during 2003 to 2008. The data analyzed using descriptive-analytical statistical method. The subjects had 34.4% creatinine level of more than 1.5 mg/dl, 16.2% hyponatermia and 9.1% hyperkalemia. Serum creatinine level was associated with hospitalization duration (P = 0.002), sex (P = 0.041), liver cirrhosis (P = 0.004) and mortality (P = 0.000). Serum potassium level was associated with creatinine level (P = 0.35), systolic blood pressure (P = 0.042), diastolic blood pressure (P = 0.046), number of comorbidities (P = 0.044), CVA (cerebrovascular accidents) (P = 0.001), taking diuretics (P = 0.006), and angiotensin converting enzyme inhibitors (ACEI) (P = 0.041). Serum sodium level was associated with comorbidities (P = 0.034). The present study showed that the clinical status of elderly patients with systolic heart failure was poor based on the hemodynamic status, electrolyte balance and renal condition. Providing comprehensive self-care training for elderly patients with systolic heart failure seems necessary in order to improve the heart disease outcomes. Nurses, therefore can reduce the hospitalization duration and improve the quality of life of the patients conducting appropriate interventions and self-care training measures.

Hospital triage is part of the emergency department structure which is done by emergency nurses. There is a little information about knowledge level of the nurses about triage. This study aimed to determine knowledge level of the nurses about hospital triage. This was a descriptive survey using simple random sampling. The researcher made questionnaire included 25 questions in three parts of demographic data, pure triage knowledge (15 questions) and triage decision making (10 questions). Seventy nurses of the emergency department participated in the study from all the hospitals of Sistan-Baluchestan province. The reliability of the questionnaire obtained 0.60 using test-retest. The data were analyzed using Kappa statistics, independent t-test, Pearson correlation coefficients through software SPSS15. The response rate was equal to 68% (70 out of 102). The nurses had not enough knowledge about the hospital triage 39.9% of the responses to the knowledge level questions were correct. Only in 3 hospitals (out of 10), special nurses have been dedicated to triage. The nurses who had more than two years experience in emergency department had received a higher average score. The concordance rate of the nurses in triage decision making was average (κ=0.56). Low knowledge of the nurses about hospital triage could be due to lack of formal training courses and lack of obligation of the emergency departments on evidence-based decision making. Establishing academic courses for nursing triage and developing national triage scale is recommended.

Since anxiety has many devastating effects on the individuals, this study aimed to determine psychological and environmental factors on anxiety level of the family of the patients hospitalized in Intensive Care Unit. This was a cross-sectional study conducted in 2007. Two hundred eighteen family members of 130 patients were selected in simple sampling method in meeting times of the Therapeutic Educational Centers. Collecting the data done using two questionnaires: “standardized hospital anxiety and depression scale” questionnaire and researcher made questionnaire. The data were analyzed using chi-square test and logistic regression. The odds ratio of anxiety outbreak in individuals who remarked that visiting behind the window affect their anxiety was 4.4 times more than that in the individuals who remarked visiting behind the window does not affect their anxiety (OR = 4.404). In addition, the odds ratio in cases with lack of face to face visiting, poor economic condition, family concerns on hospital costs and family member role changing were 3.550, 3.904, 2.501 and 4.308, respectively. Observing pipes and fittings, visiting behind the window, lack of face to face visiting, poor economic condition, family concerns about hospital costs and family member role changing were the effecting factors in increasing odds ratio of the families’ anxiety. Considering these factors and family-centered cares can significantly reduce anxiety level of the families.

Lack of application of the nursing process can reduce the quality of care so this study aimed to diagnose the nursing process barriers from the perspective of the intensive care units’ nurses in the selected hospitals of Tehran. This cross-sectional descriptive study has been done on 63 male nurses (%44.4) and female nurses (%55.6) that were chosen from selected hospitals in Tehran, based on cluster-random sampling method. The data gathered using a researcher made questionnaire. The most important individual barriers from the perspective of nurses were lack of sufficient information about concept of the nursing process (79.4%) and lack of belief in doing the patient care according to the nursing process (74.6%) and inadequate learning about the nursing process in intensive care units (71.4%). In addition, the most important management barriers were lack of enough time for doing the nursing process due to excessive number of the patients (84.1%), lack of authoritie's support for implementation of the nursing process (76.2%) and submitting non-nursing duties to the nurses (76.2%). Health care authorities must help in promotion of the health care with employing sufficient nurses, educating them and providing necessary situations for nursing process.

Cardiovascular diseases are the major cause of mortality in women and men all over the world. This study aimed to evaluate the prevalence of cardiovascular disease and associated risk factors on the citizens of Tehran city. This descriptive study has been done on 205 men and 177 women (with mean age of 74.1 ±7.87 years). Samples were chosen from different regions of Tehran city by random-cluster sampling method. Data was collected by researcher made questionnaire and also measurement of the height and weight (body-mass index or BMI), blood pressure, blood lipids and fasting blood sugar (FBS). Risk factors of CVD (and their prevalence) included obesity and overweight (48.1%), high triglyceride (37.2%), lack of exercise (36.4%), high cholesterol (32.2%), high systolic (%31.4) and diastolic (28.0%) blood pressure, cardiovascular diseases (27.3%), tobacco consumption (19.7%), high FBS (14.7%), and positive family history (13.4%). Prevalence of different risk factors of CVD was significantly higher in men than in women (P<0.05) except fasting blood sugar, physical inactivity and lack of exercise. The results of the present study showed that the prevalence of risk factors for CVD was high and higher in men than in women. Therefore, educating individuals, control of risk factors and screening are suggested.