نشریه پرستاری مراقبت ویژه
سال ششم شماره 4 (پیاپی 21، زمستان 1392)

One of the most common cardiac surgeries is valve replacement. All cardiac valve-replaced patients need to use warfarin during their life in order to reduce the risk of valvular thrombosis. There were some reports about various problems of using warfarin by considering care conditions، but there was no comprehensive study based on patients’ experiences. The present study was carried out with the aim of explaining the experiences of cardiac valve-replaced patients about using warfarin. This study was conducted with a qualitativeresearch approachand conventional content analysis in 2013. The Participants were 10 cardiac valve-replaced patients who had experiences of different time periods in Tehran and Kashan therapeutic centers and outpatients who had the experience of living with metal cardiac valves. Data collection was performed through semi-structured interview and purposive sampling and it continued until data saturation. Data analysis had been done continually and concurrently with data collection and it was performed through a comparative method. 479 codes were extracted from deep and rich descriptions of the participants. There were two main themes during data analysis process including: concern and fear of changes in the International Normalized Ratio (INR) and the struggle for the correct use of warfarin and adjustment of INR، the first theme was fear and concern about warfarin use which was consisted of five subcategories; concern on the correct use of warfarin; concern on health cares، warfarin side effects; concern on pregnancy and dental care، the second theme was effort for correct use of warfarin and regulating its use which was consisted of five subcategories: perceiving the necessity of warfarin use، adherence to the physician، self-care، physicians’ recommendations and health care and educational requirements for warfarin use. Cardiac valve-replaced patients have a permanent fear and concern during thetime of warfarin use and they try to reduce it with the correct use of warfarin and the adjustment of INR. It is necessary to help them to reduce such concerns through actual knowledge of the patients، providing post-discharge care and establishing the society for cardiac valve-replaced patients and the family.

frequent investigation of the patient for determining sedation level is one of the main measures in care of critically ill patient especially after heart surgeries. Riker scale is a valid and reliable tool which has been used in different studies as sedation-agitation scale in patients hospitalized in Intensive Care Unit (ICU). This study had been done with the aim of “investigating the effect of Riker scale on clinical outcome of patients under coronary artery bypass graft surgery (CABG)”. this clinical trial study was done in Imam Ali Hospital of Kermanshah in 2012. 116 patients، after coronary artery bypass graft surgery were selected and randomly divided into equal intervention and control groups through convenience sampling. In the intervention group، the level of patient’s sedation was monitored by Riker scale with Kappa agreement coefficient r=0. 92 and in control group it was done by a method based on physiologic responses. Data were collected with researcher-made questionnaire and checklist which had face and content validity and they were analyzed with SPSS-18 software and descriptive and inferential statistical tests (chi-square، independent t and fisher). there was a significant reduction in drug consumption of sufentanil (as sedating drugs) (8±5. 5 vs. 23±12. 5 microgram (mcg))، duration of mechanical ventilation (7. 1±2. 37 vs. 9. 3±2. 6 hours) and duration of ventilation with SIMV mode (3. 7 ± 1. 78 vs. 5. 45± 2. 14 hours) in intervention group in compare with control group (P<0/001). There wasn’t any significant difference statistically between two groups regarding length of stay in ICU and hospital and delirium appearance. Findings of this study suggest use of Riker sedation- agitation scale for monitoring awakening in patients undergoing coronary artery bypass graft surgery in ICUs with the aim of decreasing duration of mechanical ventilation and sedative drugs.

Burn pain is one of the severest and most consistent types of pain. Patients who suffer from burn usually experience the highest level of pain at the time of dressing change. The aim of the present study is “determining the effect of deep-slow and regular breathing on pain intensity of dressing in patients with burns.” This study is a randomized clinical trial in two intervention and control groups which investigate the pain in 68 patients referring to the burn ward of Kashani hospital of Shahrekord in the period of March 2011 to August 2011 through random and convenient sampling، these patients were in one of intervention or control group. Data were collected with visual analogue scale and analyzed by using SPSS، descriptive statistic test، independent t and chi - square. At first the mean of dressing pain intensity score before and after intervention in intervention group was 5/82، 3/66 and in control group was 5/3، 4/8 respectively. There was significant difference between the pain intensity after dressing in intervention and control groups (p=0. 04). Using deep-slow and regular breathing can be an important factor in reducing pain intensity during burn dressing.

Anxiety is a common phenomenon after all the surgeries. Anxiety increases metabolism، cardiovascular and gastrointestinal activity and decreases immunity. Complementary methods such as; reflexology massage are interventions that due to their simplicity and lack of need to specialists، improving blood circulation and body homeostasis are used for patients. This study was done with the aim of “comparing the effect of metatarsus and ankle reflexology massage on patients’ anxiety. In this clinical trial، the research society included men and women undergoing Coronary Artery Bypass Graft Surgery in Imam Ali hospital of Kermanshah that were randomly assigned to one of the three groups of metatarsus، ankle reflexology massage and control groups in 2012. Anxiety is measured through Spileburge’s State Anxiety Standard questionnaire; SPSS16 software، ANOVA and Mann Whitney were used for data analysis. Anxiety was decreased after using metatarsus and ankle reflexology massage. There was significant difference between state anxiety mean scores in control group and metatarsus reflexology massage group and also between control group and ankle reflexology massage group in the first day (p<0. 001).. Metatarsus and ankle reflexology massage are effective in decreasing state anxiety in patients undergoing coronary artery bypass graft surgery. Therefore it is recommended to use these complementary methods for decreasing anxiety.

although artery coronary angiography is the most important method of diagnosing cardiovascular diseases، it is an important factor in increasing patients’ anxiety. Considering that there are different medicinal and non-medicinal methods to decrease anxiety، this paper tried to study the effect of foot reflexology on the anxiety of patients undergoing artery coronary angiography. Seventy patients undergoing artery coronary angiography in Valiasr hospital Affiliated with Medical Sciences University of Birjand were assessed in 2013. They were selected through convenience sampling and divided randomly into two intervention and control groups. Spielberger state-trait inventory was used to collect data. Any patient in the intervention group received foot reflexology for 20 minutes and patients in the control group received no reflexology. The extent to which patients felt anxious in the two groups before، immediately after، and half an hour after the intervention was measured، and the data were analyzed in SPSS 16 software by Chi-square and independent t test. There was a significant difference between the two groups'' anxiety scores mean before، immediately after، and half an hour after the intervention (p=0. 096) also there was significant difference between changes in anxiety scores mean before، immediately after، and half an hour after the intervention in control and intervention groups (p<0. 001). The results of this study regarding the effect of foot reflexology massage on anxiety decrease of patients undergoing coronary angiography، in the case of results conformity in larger studies، can be used as a safe، effective، applicable and affordable intervention in decreasing patients'' anxiety in health care centers and hospitals.

One of the main duties of treatment team in ICU is relieving pain of the patients hospitalized in this ward. Using pain protocols can have positive effects in reducing pain experience of patients hospitalized in ICU. The present study has been done with the aim of “investigating the effect of applying the protocols of pain and sedation control of the patients hospitalized in intensive care unit.” In a semi experimental study in Khatamolanbia hospital of Zahedan in 2012، we surveyed 80 critically ill patients who were under mechanical ventilation. We randomly assigned patients in two control and intervention groups; while in intervention group، patients’ pain and sedation control were performed by using pain and sedation protocol; in control group، patients received usual، none protocol pain and sedation control. For data collection، behavioral pain scale (BPS) and Richmond Agitation Sedation Scale (RASS) were used. After data collection، data were analyzed by SPSS 18 software and by using descriptive and inferential statistical tests. there wasn’t any significant difference in terms of age and sex between two groups (p< 0. 264). Level of pain of patients in intervention group (protocol group) was significantly lower in compare with patients in control group (p< 0. 000). Also، level of patient’s sedation in intervention group was near to ideal sedation of Richmond in compare with patients in control group. There was statistical significant difference in sedation level of patients between the two groups (p=0. 05). Many patients in ICU experience pain as an unpleasant experience. Results of the present study showed that using pain and sedation protocol can improve pain control and also better sedation remarkably in patients hospitalized in ICU.

Understanding and meeting physiological and social needs of the family members of the patients hospitalized in ICU is very important for the nurses. This study has been done with the aim of “investigating and comparing psychosocial needs of the family members of the patients hospitalized in ICU and CCU”. This descriptive - analytical comparison study was done on 100 first-degree family members of the patients hospitalized in ICU or CCU of Khatam-ol- Anbiya hospital in Zahedan in 2011. Data were collected by the questionnaire of surveying psychosocial needs of the patients hospitalized in ICUs and they were analyzed by using SPSS 18 software، parametric t-tests and Fisher’s exact test. there was significant statistical difference between two groups in some items such as; need to meeting and changing in its times، nurses accepted the family members، talking to them about their feelings، understanding about ICU and participating in patient’s treatment (P<0. 05). considering the significance of these items into two groups، it seems that creating more opportunities for meeting and also giving more information to the family members about patients’ treatment process help to improve the psychosocial needs and reduce Psychological reactions caused by the patients’ family members in ICU

Triage is the most important measures in the emergency ward. Accurate triage decision has a significant impact on patients’ outcomes. The aim of the present study was to investigate the factors influencing triage decision making in the emergency wards. All physicians (N=22) and nurses (N= 135) in 18 emergency wards of Tabriz hospitals participated in this descriptive study. For data collection a questionnaire was used that assessed staff and non-staff related factors (including patients and emergency ward related factors) that influencing triage decision making. Social- Demographic and professional information of staff was assessed by a checklist. Data analysis was performed by SPSS statistical software and descriptive statistics. The most important factors in staff related factors were experience and skill in non-staff factors related to patient vital signs and type of injury; and in non-staff factors related to ward were overcrowding and probability of injury to the patient. Also، it was found that the basis of decision-taking regarding staff and non- staff factors related to patient was correct، but this basis regarding none-staff factors related to the ward was incorrect. The results showed that the quality of triage decision-making among staff working in emergency wards can be improved by enhancing the quality of clinical wards’ structure.