نشریه پرستاری مراقبت ویژه
سال پنجم شماره 3 (پیاپی 16، پاییز 1391)

Although hemodialysis has an important role in prolonging the life expectancy of patients with chronic renal failure, the patients are facing further complications. Pain during insertion of vascular needles is the most high stress part of a hemodialysis treatment, so it is important to find ways to reduce pain in these patients. This study was conducted to determine the effect of transcutaneous electrical nerve stimulation (TENS) on the pain intensity when the needles are inserted into vascular access for hemodialysis. A semi-experimental and double blind study was performed on 30 patients in hemodialysis ward of Semnan Fatemieh hospital. In this study, pain intensity during insertion of hemodialysis vascular needles was measured by a numerical pain scale in a one group by using TENS and TENS placebo. The pair T test was used to determine pain intensity mean difference in two conditions. Overall, the results showed that the mean pain intensity was 3.3±2.13 and 3.56±2.16 in two conditions using TENS and TENS placebo, respectively. However, no significant difference was found between the mean pain intensity in two conditions statistically by using pair T test (p=0/55). 13/2 ± 3/3 Results showed that it cannot say, TENS is effective in reducing pain during insertion of vascular needles. The reason for this finding may be related to neuropathy and skin changes present at the insertion site of hemodialysis needles. It is recommended that nurses investigate the other methods for reducing pain in these patients. Keywords:

Patients under mechanical ventilation suffer agitation and lack of forbearance due to different reasons, which bring about changes in arterial oxygen saturation. Thus medicinal treatments are often used, which exact various complications. A touch could be an influential physiologic, non-medicinal stimulus in this procedure. Therefore this study conducted to determine the effect of touch on the level of arterial oxygen saturation in agitated patients under mechanical ventilation. The present study is an Interventional study of an after-and-before design, which was conducted on 35 patients under mechanical ventilation, who were hospitalized in the intensive care unit (ICU). These patients aged from 35 to 60. Sampling was carried out based on simple sampling of patients hospitalized in general ICU at Day Hospital, Tehran. In the way that in the intervention group, the nurse touched the patient while standing by him/her. Then the level of arterial blood oxygen saturation was measured by pulse oximeter before and after intervention. The achieved results were assessed by using software SPSS-16 and statistical tests and a significant level of less than 0.05 was accepted. According to the data analyzing, the difference of the changes in the arterial oxygen saturation level was significant before and after intervention (along with touch) (p< 0.001) but while there wasn’t any touch, this difference wasn’t significant (p= 0.071 Touch improves the respiratory status and raises the level of arterial oxygen saturation in patients under mechanical ventilation. Thus it is recommended non- medicinal measures such as touch be taken in order to improve the respiratory status of the patients under mechanical ventilation.

Heart surgery is an invasive procedure which results in more anxiety, stress a nd some complication among the patients. Nurses should choose measures to reduce anxiety and stress for these patients. Studies have suggested that music can decrease anxiety in hospitalized patients. This study focused on the music listening and intensive care unit (ICU) visits effects for the control of anxiety, stress, and depression levels of patients who were candidates for heart surgeries. In a quasi-experimental, pretest-posttest design, 150 patients were randomly assigned to either control or experimental groups. Experimental groups received music listening or a visit of ICU program. Levels of variables measured before and after interventions, by using the Depression, Anxiety, and Stress Scale (DASS-21). The sample was consisted of 57% males and 43% females. Before intervention there were no significance differences (p>0.05) of the scores means of DAS-21. But, after interventions, the scores means of anxiety were 4.25 ± 2.60 (music group), 4.35 ± 2.91 (ICU visits), and 7.12 ± 3.45 (control group). Also the scores means of stress were 8.94 ± 3.28, 8.673 ± 3.57, and 13.59 ± 4.32, respectively. Additionally, the scores means of depression in the music group were 2.05 ± 1.87 and in the ICU visits group was 2.13 ± 1.28, meanwhile it was 3.27 ± 2.65 at the control group. Listening to music or ICU visits program may reduce the anxiety, stress, and depression level of patients who undergoing to the heart surgeries, therefore may be useful to use them as a nursing care intervention in the patients.

Music as a non-pharmacological and inexpensive nursing intervention can be used easily as complementary technique and can be effective in reducing pain with other methods. The aim of this study was to investigate the effect of music therapy on postoperative pain intensity in patients under spinal anesthesia. In this semi-experimental study which has been done in 2011 in the operation room of Baqiyatallah and Khanevadeh hospital in Tehran, sixty male in ASA (American society of Anesthesiological) 1 between 18-44 years old undergoing urological and abdominal surgeries with spinal anethesia were studied. Patients were randomly divided into two groups of thirty persons. Patients in music group listened to Huan Sepastian Bakh''s music about six minutes after induction of spinal anesthesia to the end by headphones. The control group did not receive any intervention. About three hours after surgery and before receiving any narcotic drugs, postoperative pain was measured and recorded by visual analog scale. Also consumption of narcotic drugs was recorded in the 24 hours after surgery. Comparison of pain intensity after the operation has been done in two groups by using Manvitni test. Findings of the study showed that music group shows a significant decrease compared to the control group (p=0.005). Pethedine consumption had a significant difference after surgery in both groups (p=0.041). Hearing the music during surgery with spinal anesthesia can reduce postoperative pain. The researcher offers to use music as a complementary method in patients in order to reduce prospective pain.

The chronic renal failure and the subsequent hemodialysis and its consequent problems such as restless legs syndrome affect the individual’s quality of life through the changes they cause in his life style and health status. The present study was conducted to investigate the association between the quality of life and restless legs syndrome in hemodialysis patients.

In this descriptive –analytical study, 171patients who were undergoing to hemodialysis at hospitals of ChaharMahal and Bakhtiariprovenance selected via census sampling. The subjects divided into two groups; one suffering from the restless legs syndrome and the other without syndrome. Data was collected using WHO-QOL BREF quality of life questionnaire and restless legs syndrome questionnaire, then it was analyzed by the software SPSS 15 and independent statistical t-test.

The findings revealed that 98(57.3%) out of 171 hemodialysis patients, who were studied, suffered from restless legs syndrome and 73(%42.7) subjects were without syndrome. The average age in the group suffering the syndrome was 59.27 ± 16.86 and in the group without syndrome was 55.20 ± 17.95.However the difference between the average age in both groups was not statistically significant (p= 0.131).The average quality of life in the group suffering the syndrome was 32.82 ± 8.53and in the group without the syndrome was 39 ± 14.57. This difference was statistically significant (p<0.05).

regarding the result of the study, the average quality of life in hemodialysis patients is low. Patients suffering from restless legs syndrome also have lower quality of life. Therefore it is recommended that the quality of life of these patients be improved through taking

According to the nature of their illness, dialysis patients should have a clear perception of it. Nurses can influence patients’ quality of life through perception-basedinterferences. The present study seeks to determine the relationship between illness perception and quality of life. Additionally, it tries to find out predictive variables of quality of life based on illness perception dimensions. 120 dialysis patients participated in this descriptive-correlation study in 2010-2011. The patients were admitted in Taleghani Hospital of Urmia. The required data was collected by the use of a demographic data questionnaire, a briefillness perception questionnaire (IPQ-B), andstandard quality of life questionnaire (SF-12).The data was analyzed using Pearson correlation test and stepwise regression analysis. There was an inverse correlation between parameters of consequences, nature of illness, anxiety, emotional response and quality of life (p<0.05). Stepwise regression analysis showed that parameters of consequences, nature of illness and emotional response significantly participated in determining the quality of life variance. Based on the achieved results of the present study, nurses can improve the quality of life inhemodialysis patients through presenting proper training and consulting courses to patients and their families about treating options and nature of illnesses and also by having them participate in health improvement programs.

Because of increased critical situation in the world, it is essential for all health care professionals, especially nurses, to be ready to manage emergency situations. T his study assessed the educational nee ds of nurses for critical situations preparedness on which, educational planning could be done. According to a d escriptive cross-sectional study design, emergency nurses (No. 140) in Tabriz’s educational hospitals selected. Emergency Preparedness Information Questionnaire (EPIQ) was used as a tools to assess preparedness of nurse parts. The questionnaire consisted of two parts. The part one, consisted of demographic profile questions and part 2, EPIQ, included of 44 questions in the eight subs-scales. Data analyzed by using SPSS ver. 17 software. Data analysis showed 66.6% of samples were female. 44% of the nurses had no experience of s pecial training in crisis situations. The total score of emergency condition preparedness of sample was (2.30 ± 0.97); the lowest and highest scores of the subject was Reporting and Accessing Critical Resources subscale (2.03 ± 0.9) and Triage subscale (2.51 ± 0.7) respectivly. The mean scores of each items, in all eight sections (e xcept triage), were moderate to low. According to the results, the emergency nurses are not prepared enough to respond appropriately in crisis situations. Therefore crisis situations trainings should be offered for the nurses as Continuing education. In addition, the development of crisis nursing courses in nursing post graduate departments is suggested.

In the critical life threatening situations, efforts of the emergency centers personnel are to eliminate the threatening factors, to keep airways open and save the victim life. To achieve these aims, proper equipments such as instruments for opening and keeping airways open are important. The aim of this study was to survey the status of equipment which are used for airway management of victims in critical situations by personnel of Mazandaran emergent teams.

By using a descriptive study design, Mazandaran province divided into three geographic zones included West, East and Center zone. Three cities randomly chosen from each zone. Emergency centers of these selected cities visited research team members and by using of a checklist, all airways management equipments such as endotracheal tubes, airways, and Ambu bag, a flexible reservoir bag connected by tubing and a non-rebreathing valve to a face mask or endotracheal tube which used for artificial ventilation, surveyed.

Data analysis indicated, there is some deficiency in the airways management equipments. There were no infants endotracheal tubes with internal diameter size of 3.5-2.5 mm in the 30% of centers. In the 95% of the centers there were adult endotracheal tubes with internal diameter size of 6-7.5 mm. There were Ambu bag and oropharynx airways in the 86% and 84% of centers respectively. There weren''t any nasopharynx airways. Only 84% of centers had proper endotrcheal suction equipments.

It is necessary to revise the list of equipment and also to provide new devices or/and repair some the airways management equipments of emergency centers.