نشریه پرستاری مراقبت ویژه
سال چهارم شماره 3 (پیاپی 12، پاییز 1390)

Patients with blood cancer are encountering numerous problems following bone marrow transplantation which exert negative impact on self-care self efficacy. The present study has been conducted to determine the effect of health-promotion strategies on self-care self-efficacy among patients undergoing bone marrow transplantation. This before- after semi experimental study was performed among patients candidate for bone marrow transplantation in Shariati Hospital of Tehran in 2009. Sixty patients were randomly allocated into two groups of 30 participants each as experimental and control groups; the former received education on health promotion strategies and the latter was treated according to the ward's routine. Self efficacy was compared between the two groups before and thirty days after the intervention. Data were analyzed by SPSS11.5 statistical software using descriptive statistics, independent and paired t-test, covariance analysis and chi-square. No significant difference was observed between the two groups in terms of demographic variables. The self-efficacy scale was increased in general comparison as well as adaptability, decision-making and stress reduction parameters in control with respect to the experimental group and also at post compared to pre-intervention in both groups (p<0.001). The mean self-efficacy scores was statistically different in all dimensions after in comparison with before the intervention (p<0.05). Education on health promotion strategies to bone marrow transplant patients can increase patient's confidence in performing self-care processes and consequently brings more survival along with higher quality of life among this group.

Pre-suctioning normal saline instillation into the trachea is a traditional nursing intervention. In this line, the present study has been carried out to “evaluate the effect of endotracheal suctioning with and without normal saline solution on heart rate and oxygen saturation”.

This semi-experimental study with crossover design was conducted on 50 trauma patients admitted to critical care unit of Shahid Bahonar Hospital of Kerman in 2010. For each patient, suctioning was performed once without and once with 5ml normal saline solution. Heart rate and oxygen saturation were measured and recorded at one, two and five minutes before and after suctioning by standard monitoring apparatus. Data were analyzed by SPSS17 statistical software using independent and paired t-tests.

Heart rate was increased in both groups after the suctioning; however, it was slightly more in group receiving normal saline but not statistically significant. Negative changes in oxygen saturation were higher in saline group compared to the other (p<0.05).

Normal saline instillation prior to suctioning will be accompanied by reduced oxygen saturation, and it is recommended that more suitable approaches, such as moisturizing the inhaled gas, be used for diluting secretions to minimize the related side effects.

Warrior's education and complete domination over self-aid and buddy-aid is one the most effective approaches for enhancing their safety in military operations. The present study has been performed to “investigate the effect of self-aid and buddy-aid education using lecture and multimedia software package on performance level of military personnel”. In this semi-experimental study in 2010, sixty subjects from the selected military battalion of Tehran and Mashhad were investigated. Participants were randomly allocated into two groups of thirty each and were educated using lecture and multimedia software package. In the end, they were evaluated in terms of performance level through objective structured clinical examination. Data were analyzed by SPSS15 statistical software and nonparametric statistical tests. At "vital signs monitoring," "carrying method of injured," "head bandage," "self-care and decontamination of biological attacks," stations, no significant difference was observed between the two groups (p>0.05); while, in "cardiac and pulmonary rehabilitation," "first-aid measures for eye burns," and "splinting" stations, the results indicated a statistical difference by Man-Whitney (P<0.001). In "bleeding monitoring" station, lecture-trained group showed more acceptable results compared to software-educated group (p<0.05). Regarding more effectiveness of multimedia software in some stations, especially CPR, and considering lecture-related limitations, expanding multimedia software application is recommended in self-aid and buddy-aid education.

Sleep is one of the basic human needs and sleep deprivation causes numerous adverse effects on the human body and mind. Due to reduced sleep quality in patients with acute coronary syndrome, this study was carried out to " determine the effect of earplugs on sleep quality in patients with acute coronary syndrome. " In this two-group controlled clinical trial, sixty patients with acute coronary syndrome in the coronary care units of Baqiyatallah hospital in Tehran in 2010, were selected by purposeful sampling method and randomly allocated in two groups of case and control. In the case group, in the second night stay, the intervention of earplugs was done per night and by using the Petersburg's sleep quality questionnaire; sleep quality was evaluated during and at the end of hospitalization. Then data were analyzed by paired T test, independ T test, Spearman and Pearson's correlation coefficient and SPSS 19 software. Total sleep quality, score in case group was significantly decreased after intervention (6.3±2.1) than before intervention (10.3±6.3) (p<0.001). Also, total score of sleep quality after intervention in case group (6.3±2.1) has significant different compared to control group (9.1±4.8) (p<0.001). Using earplugs, as an economical and uncomplicated method, can improve sleep quality in patients with acute coronary syndrome in the coronary care units and can be used as an alternative method of treatment instead of drug therapy.

Nurses as the major group of health service providers need to have the satisfactory quality of work life in order to give desirably care for the patients. The purpose of this research has been to study the “Relationship between psychological problems and quality of work life of intensive care unit nurses”. This cross-sectional study which is descriptive –correlation was accomplished on 143 nurses working in intensive care unit of Tehran hospitals in 2010. Data with using of three questionnaires including demographic characteristics, questionnaire of quality of work life based on Walton’s model and the standard questionnaire of DASS21 was gathered. The information was analyzed using SPSS16 software and Pearson correlation test and chi-square test. There has been no correlation between quality of work life and stress (p=0.07) and depression (p=0.05), but there has been a weak inverse correlation with anxiety (p=0.002, r=-0/27). It is essential to consider nurses’ anxiety especially by directors due to anxiety impact on reduction of nurses’ quality of work life.

Hospitalization, especially in intensive care unit, because of its specific conditions and characteristics can be stressful. The purpose of this study was to determine the stressors associated with hospitalization in the cardiac care unit patients. This cross-sectional study was conducted by convenience sampling method on 150 patients who were hospitalized in the cardiac care unit of Ramsar’s Imam Sajjad Hospital, in 2009. Data collection tools included personal details and the Valiser questionnaire. To analyze the gathered data, a parametric test was carried out and SPSS18 software was utilized. . The highest physical stressful factor was insomnia which was a result of being connected to a monitor; the main psychological stressor was the difficulty in saying prayers and requesting catheter and bedpan; and finally the major environmental stressor was the voice of others’ talking. A significant relationship was observed between the psychological stressors scores and gender, employment status and educational level of patients (p<0.05). There was also a meaningful relationship between the physical stressors scores and employment status of patients and the number of hospitalized people in the past year (p<0.05). The findings can help nurses to identify stressors and toimprove the quality of nursing care.

Aimes: In renal replacement therapies, the goal is not only prolonging life and maintaining health, but also maintaining and improving the quality of life. This study seeks to "evaluate the quality of life of kidney transplant patients." This cross-sectional investigation, which was performed in 2009 in Tehran, studied 220 patients with kidney transplant and was conducted by the method of convenience sampling. Data collection tools include a demographic data collection form and a questionnaire which measured quality of life (SF-36). Data were analyzed log SPSS14 statistical software and descriptive and inferential statistical tests. The mean quality of life in these patients was 60.6 ± 18.7, the highest and lowest scores respectively on the pain scale were 66.27 ± 28.84, and working limitations due to physical disabilities were 46.67 ± 36.91. A significant relation was found between the overall quality of life score and gender (p=0.001). However, no significant relation was observed between the overall quality of life score and other demographic variables (p>0.05). The patients’ average quality of life, in this study, was a bit more than medium. Regarding transplant expenses and psychological and financial pressures on patients and their families, it seems vital to recognize the difficulties and impediments that the patients confront in their lives.

Restless Legs Syndrome is a movement disorder characterized by a compelling urge to move the legs during rest or inactivity. Patients often experience muscle twitching leading to sleep disturbance. Restless legs syndrome is more prevalent among patients in critical care units than ordinary people. Hence, the present study has been implemented to "investigate the correlation between restless legs syndrome and sleep disturbance." In this descriptive-analytic study in 2010, 30 patients admitted to critical care units of University of Medical Sciences affiliated hospitals of Urmia city were selected using available-sampling method. Data-collecting instruments were information-included questionnaires on demographic characteristics, screening as well as the intensity of restless legs syndrome, and sleep quality. Data were analyzed by SPSS16 statistical software and descriptive and inferential statistical tests. 36.3% of patients in critical care units showed signs of restless legs syndrome. In groups with and without sleep disturbance, respectively 52.7% and 20% of participants were suffering from restless legs syndrome. The syndrome incidence was 4.45-fold higher in patients with than those without sleep disorder. Findings revealed that developing the mentioned syndrome is far more probable in people with compared to those without sleep disturbance. Given the high prevalence of restless legs syndrome and sleep disorder in critical care units patients, using the screening methods seems to be necessary for disorder identification and lifestyle alteration to reduce the associated risk factors among these patients.