نشریه پرستاری مراقبت ویژه
سال ششم شماره 2 (پیاپی 19، تابستان 1392)

Transition is­ a passage or movement from one stage of life، condition، or place to another. Chronic patients somehow experience transition and nurses have an important role in supporting them. This study was aimed to explore the meaning of transition to hemodialysis. In this qualitative research، hemodialysis purposeful sampling and then theoretical sampling had been continued until data saturation (13 people). Participants were hemodialysis patients that were referring to affiliated hospitals with Shahid Beheshti University of Medical Sciences and persons being in direct and close touch with them in 2012. Semi-structured interviews were undertaken and field notes and memos were used for data collection. The data were analyzed by content analysis. Data rigor was confirmed by Lincoln & Goba criteria. Ethical considerations were observed. The participants showed dual meanings of transition to hemodialysis (positive & negative). Categories of recovery & healing way، an opportunity for interaction، an opportunity for learning، a hope point، God’s gift، and renewal life demonstrated positive meanings of transition to hemodialysis. Categories of valueless of hemodialysis، useless living with hemodialysis، life bitterness with hemodialysis، and hardship of living with hemodialysis and tragedy of life with hemodialysis، demonstrated negative meanings of transition to hemodialysis. Considering complexity and multidimensionality of transition and influences of means associated with transition and formation of intensity and nature of the consequences that clients experience، must be relied on reinforcing positive meanings of transition to hemodialysis in nursing care.

Illness perception plays an important role in se lf-care behavior and treatment adherence in hemodialysis patients. So interventions that promote illness perception can cause improvement in treatment adherence of Hemodialysis patients. Hence، this study had been conducted with the aim of determining the effect of illness perception promoting interventions on treatment adherence in hemodialysis patients. In this randomized clinical trial، 71 patients undergoing hemodialysis were allocated randomly to the intervention (n=38) and control (n=33) groups. For data collection، a two-part questionnaire consists of socio-demographic questionnaire and questionnaire of treatment adherence of hemodialysis patients (ESRD-AQ) were used. After pretest، patients in intervention group received illness perception promoting interventions individually for six sessions and control group just received routine care of the unit. Posttest was done 8 weeks after the end of intervention. The data of the study were analyzed by using SPSS-16 software and independent and paired T test. Results showed that patients participating in illness perception promoting interventions had significantly higher scores in the areas of adherence to medication (p=0. 01)، adherence to liquid limitation (p=0. 001)، adherence to dietary restriction (p=0. 001) and shortening durance of the hemodialysis sessions (p= 0. 04) than patients in control group. Illness perception promoting interventions causes improvement in some dimensions of treatment adherence in hemodialysis patients. Considering inadequate research literature، there is a need for more research in this area.

Pain is the main complain of hospitalized patients suffering from burns. Anxiety، troubled interaction with others، disturbed sleep، movement defect، loss of appetite، low quality of life، and increase in healthcare and hospitalization costs are the consequences of non-alleviated pain and pruritus. Regarding this the present study aimed to investigate the effectiveness of muscle relaxation on severity of pain، pruritus and vital signs among patients suffering from burns. In a semi-experiment study and by using a simple convenient sampling method، 110 hospitalized patients of Burn Ward were randomly chosen in two separated stages and allocated to case and control groups. It took two consecutive months to choose the controls and cases respectively. Tools for data gathering were as follows; demographic information، a pain visual analogue scale، and pruritus assessment scale and documentation form (vital signs، pruritus، pain). As the desired intervention، cases were delivered a twenty-minute Benson muscle relaxation and then their pain، pruritus and vital signs were measured and compared to these in controls. Achieved data were analyzed by SPSS software. There were no significant differences between severity of pain (mean of pain in controls and cases were 5. 8 and 6. 3 respectively)، itching (mean of pruritus in controls and cases were 3. 5 and 2. 6 respectively)، and vital signs (respiration، pulse rate، blood pressure، perspiration and dilated pupils) in two groups (p>0. 05). But، conversely، a post-intervention independent t-test revealed that there were significant differences between severity of pain (mean of pain in controls and cases were 5. 5 and 2. 2 respectively)، itching (mean of pruritus in controls and cases were 3. 6 and 2. 1 respectively) and vital signs (respiration، pulse، perspiration and dilated pupils) in two compared groups (p<0. 05). However، blood pressure showed no significant difference between two groups after intervention. Muscle relaxation technique can be effective in relieving the pain، pruritus and vital signs of patients suffering from burns. Therefore، its use as a therapeutic and alleviative method could be suggested for patients suffering from burns.

Due to increasing the number of Hemodialysis patients and also the necessity of consistent and continuous cares by family members to patients، we have been up to doing a test in order to find out the effects of oral Vitamin C on tiredness and exhaustion of hemodialysis patient caregivers according to researches that have been done on the effect of oral Vitamin C on fatigue. This research is a before-after one-group semi experimental study of a that has been done in 2012. The samples were 25 caregivers who have been coming to the selected hospital in Tehran and they had been chosen randomly and purposively. At first The Multidimensional Fatigue Inventory MFI-20 Questionnaire was completed by research samples before intervention and after a month of using oral Vitamin C the Questionnaire was completed once again. After collecting the data by descriptive statistics and paired t-test the data had been analyzed by SPSS 17 software. The samples were 48% male with the age average of 44. 4 and 72% married. In general exhaustion and fatigue، physical fatigue، mental fatigue and reduced activity dimensions significant difference (p<0. 05) had been observed but there was no significant difference in the reduced motivation dimension. According to the results، using oral Vitamin C can be recommended for reducing the fatigue of caregivers and thereupon increasing the quality of care given to Hemodialysis patients.

Myocardial Infarction is the most common disease in industrial countries. Changing lifestyle is necessary for decreasing heart diseases. This study had been done with the aim of assessing the effect of healthy belief model application on health behaviors of patients with Myocardial Infarction. In this quasi-experimental research، 74 samples had been chosen by purposeful sampling method they were in two experimental and control groups in Kermanshah in 2011. Experimental group achieved education based on health belief model for health behaviors and control group achieved traditional education. The data were gathered by a questionnaire with reliability of r=0. 81 and collection checklist and statistical analysis with SPSS-18 software and descriptive and inferential statistical tests. The averages age of the two groups were the same and most of the samples were males. There was signification difference between model concepts in both groups in the stage after interference in all elements except nutritional function (p=0. 001). In order to increase knowledge and improvement of activity function of the patients with Myocardial Infarction، it is recommended to use health belief model but education with this model did not have any tremendous impact on nutritional function.

According to this approach that: “standardization of nursing care according to the last evidences has the best results in increasing care quality”، the aim of this study has been determined: “Designing evidence based nursing care instructions for mechanically ventilated patients”. The study had been done with “developmental research” method with the approach based on evidences in Intensive Care Units of Baqiyatallah hospital in 1392. At first quality of 15 present instructions in Intensive Care Units had been evaluated in three levels of weak، moderate and good. Then 22 new instructions had been designed according to Stetler model and with the approach based on evidences. For assessing content validity of the instructions، opinions of ten faculty members of Baqiyatallah، Tehran and Shahid Beheshti Universities had been considered in three refers by Delfi method. Applicability of the instructions had been assessed by focused group discussion method with experienced experts of Intensive Care Units. Evaluation of the 15 present instructions showed that their quality is in the medium. In addition to reviewing nursing books، 655 articles had been studied، and with considering criteria of choosing evidences، 121 articles had been chosen as credible evidences. At the end 22 care instructions with good quality had been designed. Lack of specification of the present instructions and their low quality showed necessity of designing instructions based on evidences with high quality and specifically for different units. Designing such instructions prepares background of using nursing studies at bedside and it is going to be an effective step for based on evidence nursing. So it is recommend that designing such application instructions should be in the priority of the next studies.

Level of quality of life in hemodialysis patients change following stressful factors. Patients use different coping mechanisms in order to deal with stressful factors. The aim of this study was to determine stressful factors، coping mechanisms and quality of life among hemodialysis patients. This descriptive analytic study was done on 113 hemodialysis patients in Babol’s Shahid Beheshti hospital in 2010-2011. The data collection tools included questionnaire of hemodialysis stressful factors information (HSS)، Jalowice & Powers coping methods and quality of life Index of Parila et al. in order to analyze data، descriptive analytical statistics (Independent T - test، variance and Pearson ''s analysis and SPSS 17 software had been used. 50. 4 % of the patients were male. The age range of the patients was 87-18. The results showed that there was significant relationship between age with physiological stressful factors (p = 0. 050) and there was significant relationship between residency and psychological stressful factors) and between important activities of life and variables of occupation and marital status (p=0. 000 both). In dealing with stressful factors patients mostly used emotion-oriented coping methods، and there was positive and linearly relationship between emotion-oriented coping methods with psycho and social stressful factors (p=0. 000 and p=0. 009). There was positive and linear relationship between problem–oriented coping methods with aspects of overall quality of life and also there was significant inverse relationship between emotion-oriented coping methods with important activities of life، overall quality of life and physical condition. By identifying the stressful factors in hemodialysis patients، it is possible to have more valuable step through more effective nursing services and producing basic programs such as psychology counseling for strengthening problem - oriented coping mechanisms and improving their quality of life.

Patients’ classification based on different needs in order to take appropriate decision with the aim of gaining maximum benefit is necessary for the patient. The present study had been done with the aim of assessing characters of the patients suffering from Acute Coronary Syndrome in cardiac care units based on synergy model. This is a descriptive – analytical study، convenience sampling had been done including 800 patients that were hospitalized by diagnosis of ACS in CCU of Jahrom Medical science University hospitals in 2012. In order to collect data “assessment of patients’ characteristics based on synergy model” checklist with “inquiry” method had been used. In order to analyze data SPSS 16 software and descriptive and inferential statistical methods and Kendal and Spearman correlation coefficients had been used. In the samples of the study 50. 5% were male. The average age of the patients was 61. 20±1. 26. Findings showed that the maximum frequency of the patients considering vulnerability and complexity in level 1، in the case of stability and partnership in taking decision in level 3 and in the characteristics of returning، sources، partnership in taking care and anticipation، was in level 5. Hospitalized patients suffering from ACS includes a wide range in severity of disease، clinical signs and individual and social conditions. Therefore، categorization based on different conditions for providing appropriate decision and strategy aimed at gaining maximum benefit is necessary for the patient. Using synergy model leads to predicting care needs of the patients.