نشریه پرستاری مراقبت ویژه
سال ششم شماره 1 (پیاپی 18، بهار 1392)

open heart surgery is a stressful experience for the patients and their family. Patients from admission time to discharge experience different level of anxiety and in order to cope with that they use some strategies. This study had been done with the aim of identification of the experiences of open heart surgery patients from admission to discharge.

Samples had been chosen purposefully from 8 women and 10 men who were under open heart surgery in three centers of educational hospitals of Tehran in 2012. Data were collected through unstructured interviews. With qualitative approach of analyzing the content of Graneheim&Lundman 2004had been analyzed.

From analyzing data three themes including Stuckat thecrossroadsof deaththreats, seeking a way to stay and forced to compromise with the situation had been emerged. Themes and subthemes indicate anxieties and strategies of the patients in hospital environment.

Facing several stressful factors during care period and not meeting physical, psychological and educational needs lead to feeling fear and threat in the patients. Patients’ attempt in these adverse care conditions is self-protection with using different strategies. So real identification of patients’ needs and anxieties is very important in clinical nurses’ care planning.

The frequency of organ transplantation in Iran in compare with European countries and United States is remarkably low and it is because of transplantable organ shortage and because of this thousands of people have been died annually, this is while we encounter with some cases of brain death every day that the organs of these patients with brain death can save life of the patients who are in need of these organs. The aim of this study was “to assess the effect of education on knowledge and attitude of nurses about organ donation”.

This research was a semi-experimental in the form of test-retest study. The group of the study was 120 nurses of ICU and emergency wards of Kerman hospitals who participated in the educational seminar of brain death. Data were collected by a self-designed questionnaire. The questionnaire was completed by the nurses once in the first day of the seminar (before education) and once after presenting related education (after two weeks).

Results showed that before education the least knowledge was about three organs of lung, pancreas and marrow that it was 73.3%, 57.5%, and 54.2% respectively, while after education it had been increased 95%, 91.7% and 80%, respectively (P<0.001). The average of nurses’ knowledge about process of brain death and donation after education was 9.4 (±0.78) that in compare with before education had 7.5 (± 2.6) significant increase (P<0.001). Total average of nurses’ attitude towards process of brain death and organ donation before training course was 65.7 (±13.7) which had been significantly increased to 76.9 (±8.7) two weeks after education (P<0.001).

The present study showed that more educational programs are necessary for increasing knowledge about brain death and organ donation among health staff especially in ICU and emergency wards that are starter of diagnosis process of brain death patients. Special education should be started from university level and should be continued in the form of in-service training. It is clear that these efforts are going to make remarkable increase of positive attitudes towards organ donation in Iran.

One of the common medical errors is medication errors. Since medication errors are doubly important in neonatal units and neonatal intensive care units, prevention of these errors are very important and necessary. The aim of this study has been determining the level and the type of medication errors in neonatal units and neonatal care units. The present research was a descriptive-correlative study. The method of sampling was census and included 119 nurses working in the neonatal units and neonatal intensive care units in 5 educational hospitals of ShahidBeheshti University of Medical Sciences. The data collection tool was questionnaire. The first questionnaire contained the demographic data. The second questionnaire was “Medication Administration Error” in order to determine the level and types of medication errors) and they were used after that their validity and reliability were examined. The collected data were analyzed by SPSS 18 software. 11.8 percent of the nurses indicated that during the last 6 months they did not commit medication errors and 37.8 percent of them had between 1 to 2 medication errors. Medication errors in injectable drugs respectively included; error in time of administration of medication (51 to 60 percent), errors in pharmaceutical calculations (51 to 60 percent), neglecting the drug interaction in simultaneous prescription of drugs (51 to 60 percent), wrong dose of a drug (41 to 50 percent) and medication errors in non-injectable medications included respectively in medication calculations (51 to 60 percent) and after that error in medication dose (41 to 50 percent). Correlation between injectable and non-injectable medication showed that error is mostly in injectable drugs and nurses who have error in injectable medication also have errors in non-injectable medications. Identification of types and level of medication errors can lead to steps towards prevention of these errors and advancement in the increase of quality of neonatal care and safety.

This study has been done with the aim of assessing the effect of patient’s education and telephone follow up by nurse on readmissions of the patients with heart failure. In this experimental study that had been done in 2011, 189 heart failure patients hospitalized in ShahidRajayee cardiovascular hospital were selected by purposive sampling method and they were randomly divided into 3 control or intervention groups. The control group received only hospital routine care. The first intervention group received one hour face to face education and one educational researcher made booklet at the time of discharge. Second intervention group in addition to receiving one hour face to face education and educational booklet at the time of discharge, received telephone follow up by nurse for the next 3 months. Data collection tools included demographic questionnaire and readmission check lists. Data were analyzed by statistical tests and spss16 software. patient’s education during discharge and telephone follow up after discharge decrease readmission level significantly. After 3 months of follow-up there was significant difference respectively for hospital, clinical and doctor’s office readmissions (p=0.06), (p=000) (p=000) between groups. Patients’ rapid follow up after discharge can be suggested as away in order to decrease readmissions.

Fatigueis afrequentsymptomin hemodialysis patients that impairs the quality of lifeand like painandfever;it isan importantbiologicalwarningfor human health. So far, despitethe manyinterventionsto reducefatiguein hemodialysis patients, still this phenomenon is reported with high prevalence. The aimof thisstudy was to determinethe effectof vitaminB 12 supplementationon fatigueinpatientsundergoing hemodialysis. It was a semi experimental study with the method of before-after, which has been done on 86 hemodialysis patients with a Purposivesampling method within 3 months in 2011 in 1 and 2 chosen hospitals. The intervention was an intravenous injection of 100mcg/ml of vitamin B 12 afterdialysis process which has been done 3 times a week, within 2 months and by the end of the intervention in ordertoassess sustainability of theeffect ofvitaminB12 there was no interventions for 1 month. Fatigue measurementquestionnairewas completedbyparticipants and it was analyzed by using SPSS software and descriptive statistic tests, paired t-test and analysis-variance of the repetitive measures. Fatigueafter a month ofinterfering (P=0.001)andwith further reductionafter twomonths (p=0.0001)andone monthafterthe end of intervention (P=0.021) has been significantlyreduced. The resultsindicatethe effectiveness ofvitaminB12on the reduction of fatigue in hemodialysis patients. Thus intravenous injection of 100mcg/ml of Vitamin B12 weekly after dialysis is recommended for HD patients.

the ultimate aim in myocardial infarction is exact monitoring and minimizing its aspects such as blood pressure that may be under the effect of body position in measuring time. The present study had been done with the aim of determining the effect of change in body condition on blood pressure of the patients with acute myocardial infarction hospitalized in CCU. This study is an experimental study that 85 patients who suffer from acute myocardial infarction had been chosen with the available method from 22nd of Bahman hospital of Gonabad in 2012. Patients for 15 minutes were in supine sleeping position, in the Right and left Lateral, Semi-Fowler’s and Fowler’s position and blood pressure had been measured in every one of these positions. Data had been measured with the version 14 of SPSS software and nonparametric tests (Friedman tests) and descriptive statistic including: indicators of central tendency and distribution. Amounts of P less than 0.05 had been considered significant. Data analysis showed significant difference between blood pressure amounts in different positions. In a way that right hand and left hand systolic and diastolic blood pressures in sitting position had the most average and in the right-side sleeping position had the least average. According to the importance of regular blood pressure monitoring in these patients, choosing appropriate body position for determining real blood pressure and to be informed of its changes in different positions of body in patients who suffer from myocardial infarction is very essential.

hospitalization in CCU is always along with stress for the patients. As stress in healthy people can cause increase in heartbeat, cardiac output and blood pressure also in heart patients it can effect on physiologic factors and increase in death rate in these patients. According to the effect of emotional ties and increase of relationship with the relatives on decrease of these patients’ stress, this study had been done with the aim of determining the effect of planned meetings on physiologic indicators of the patients with ACS. This is a semi-experimental study that had been done on 72 ACS patients in CCU. Samples had been chosen with base on target method sampling and had been studied randomly in two intervention and control groups in two CCUs separately. Meeting plan in intervention group was as scheduled and included three times meeting in the second and third day of hospitalization with the presence of one to three relatives that the patient had requested and in control group it was in the form of one time meeting per day and with the presence of some open meetings. Patients’ Blood pressure, heartbeat, breathing and heart dysrhythmias were recorded every two hours in day and night and also before, after and during meeting. The results show significant decrease in physiologic indicators in the third day of hospitalization in compare with the first day in intervention group in contrast with control group, also the above variables in intervention group during meeting and after meeting were significantly less than control group. (P<0.05) Results of this study indicate that supportive effect of planed meeting on the patients is more than limited meeting and because of this it causes decrease of physiologic indicators and consequently it helps treatment quality improvement of the patients with ACS in CCU.

Humanity always think about creation of new and low cost cultures. The aim of this study is comparing the effect of follow-up care by telephone and short massage services on patient’s quality of life after cardiac valve replacement surgery. This clinical trial study was done on patients admitted for valve replacement surgery in Tehran selected hospitals in 2011.99 samples selected with based on target method and distributed according to random allocation method to telephone follow-up, short message services follow-up and control groups. In this study patient’s quality of life assessed by Nottingham quality of life questionnaire before and 3 months after surgery. The mean scores of aspects of life quality in telephone follow-up, short message services follow-up and control groups decreased after intervention (that shows the better quality of life) but Anova test did not show significant difference between the mean scores of aspects of life quality in the groups before and after intervention. There was no significant difference between follow-up care by telephone and short massage services on patients’ quality of life after cardiac valve replacement surgery. We hope to see more usage of easy and low cost follow up care methods in cardiac care centers.