Evidence Based Care
Volume:3 Issue: 4, 2014

Emergency ward is among hospital areas with high risk of errors، thus، implementing measures to identify and correct the errors is essential. The object of this study is to identify and assess the errors of the process of admitting patients in Emergency Department of Imam Reza Hospital using Failure Mode Effects Analysis، as one of the tools to assess and manage risk، as well as proposing actions to improve the process. In this descriptive study، the potential modes of error related to the admission process was evaluated and analyzed by FMEA methodology. The data was collected through group interviews and holding weekly meetings with group members using the techniques of brainstorming and fishbone diagram، and the results were registered in the final FMEA worksheet. Using FMEA methodology، 37 modes of potential errors in admission process of the Emergency Department were identified and analyzed، with the reliability of 85%، 13 modes of error with RPN≥140 as high risk errors were identified in three areas of errors related to nurses، doctors and errors associated with patients، then measures and solutions were proposed to reduce each of these errors. Applying Failure Mode Effects Analysis in a critical and high demanding ward such as Emergency Department helps to identify and correct the errors، while proposed measures for each of the errors are highly applicable regarding team composition.

In attention of increasing prevalence psychological problems، complications and consequences of hemodialies and important role of nurses in psychological support of patients، application of complementary therapies such as spirituality counseling is very important. This study investigates the effect of spirituality counseling on anxiety and depression in hemodialysis patient. This randomized clinical trial study included 90 patients with chronic renal failure undergoing hemodialysis in Amin Hospital، Isfahan (2013)، which were randomly assigned into two groups. The experimental group received 8 sessions of spiritual counseling and the control group took routine care. Data were collected with the Hospital Anxiety and Depression Scale (HADS) and were analyzed using independent and paired t-test and exact fisher test in SPSS software version 11. 5. Statistical results showed no significant difference in demographic variables between intervention and control groups (p>0/05). In addition، independent t-test showed no significant difference between the mean anxiety and depression scores in the intervention and control groups (p>0/05). However، after applying spiritual counseling، average scores of anxiety and depression decreased in intervention group in comparison with the control group. Paired t-test showed significant differences between average scores of anxiety and depression scores before and after the spiritual counseling in an intervention group (p<0/05)، while in the control group، this difference did not reach statistical significance (p>0/05). Spiritual counseling could decrease the anxiety and depression in dialysis patients; therefore it is recommended that this approach performed as a complementary، effective، non-invasive، low cost nursing intervention to decrease the psychological problems of these patients.

Gastroesophageal reflux disease is one of the most common chronic disorders of the digestive system. Almost anyone experiences heartburn or reflux (the two main symptoms of the disease) in a situation. Nutritional changes education as the first step of nursing intervention is the easiest، cheapest and the safest treatment approach. The aim of this study was to determine the effect of Temperament–based diet education on Quality of Life in patients with GERD who was admitted to Qaem Hospital in city of Mashhad. This clinical trial was a pretest/posttest experimental design with control group. A sample of 60 patients with gastroesophageal reflux disease، who had admitted to Qaem hospital from 5th March 2013 to 20th June 2013، was divided into two groups by random assignment. After verifying the patient temperament، the intervention consisted of holding nutrition education classes in accordance with temperament for 1. 5 hours and accomplishing the diet as possible for two weeks. Research tools were GasroEsophageal Reflux Syndrome Health Related Quality of Life (GERD-HRQL) questionnaire and performing diet checklist. The data was analyzed by SPSS software version 11. 5 and by using Independent T test، Paired T test and ANOVA test. With respect to the higher score of this questionnaire، it was shown to be equal to the lower quality of life situation، comparison of the mean scores difference of quality of life. One-way ANOVA in both groups showed that quality of life scores in education group (8. 80 4. 22) was significantly lower than the quality of life scores in the control group (14. 53 5. 98) after an intervention (p<0. 0001). Considering temperament in the diet education by nurses can play an important role in increasing the quality of life in patients with Gastroesophageal Reflux Disease.

One of the common socioeconomic problems of today’s world is back pain and its chronic type can cause severe pain and disability in patients. Aquatic exercise is one of the complementary therapies which are used in diseases treatments. To determine the effectiveness of aquatic exercise on pain intensity and disability of the patients with chronic low back pain. This experimental study was performed on 48 women with chronic low back pain. Sampling method and division samples into the case and control groups were performed using simple random sampling method. Data collection tools included demographic characteristic check list، VAS pain intensity control scale and Oswestry disability index questionnaire (ODI). The patients in the case group were asked to perform some special back aquatic exercise in the pool، with temperature of 30-31°C، along with the coach، three times a week (every other day) and each session lasted for 60 minutes for three months. The control group waited only for three months. The questionnaires were filled by both groups before and after the intervention. Mean age of the subjects was 43 years. Mean pain intensity scores between case and control group had a significant difference before and after the aquatic exercise (P < 0. 001). In the control group، there was also a significant difference after 3 months of waiting (P < 0. 013). Mean disability intensity before and after the aquatic exercise had a significant difference between the case and control groups (P < 0. 04)، but no significant difference was observed in the control group. Aquatic exercise was shown to be effective on the intensity of pain and disability in patients with chronic low back pain and، if considered as a treatment، can reduce the pain and disability of such patients.

Pregnancy and birth are very important for the most communities and childbearing women make decisions depends on their context during pregnancy. The aim of this study was to explore the perception and inner experiences of Iranian pregnant women. A qualitative content analysis was conducted in 2013. Participants consisted of 18 mothers who had experienced pregnancy in Tehran. Sampling was purposeful and continued until data saturation. Finally، 28 interviews were conducted with an average of 50 minutes. Analysis of collected data was performed concurrently with a constant comparative approach. Two major themes emerged during the analysis process involving «in the hope of a brighter future for the unborn child» and” in the hope of a brighter future for themselves «. These concepts are important childbearing women’s perspectives of» Providence«for themselves and their unborn children. Understanding subjective resources of Iranian women’s experiences results in correct understanding of their true needs. It should be followed by more effective planning and caring with practitioners of the community health centers.

Metabolic control of diabetics Type 1 in each period of life، like adolescence is stressful and using partnership caring model is eesential. The aim of the present study was to determine the effect of using partnership caring model on Diabetic adolescence s’ Metabolic Control. This research is a semi- empirical study performed in a Diabetes Center of Arbil city (2012-2013). Forty diabetic adolescents have been designated into two groups of 20 members. The partnership caring model was performed in four stages of motivation، preparation، execution and evaluation in an intervention group for three months. Control index of diabetes was the amount of used HbA1C and Insulin level which was measured in both groups before and after the interference. Data were analyzed by SPSS version 16. 0 using paired-t and independent-t tests. T-test revealed that before interference، both groups were similar regarding the amount of HbA1C (p= 0. 77) and Insulin level (p= 0. 10). However، after interference، the T-test indicated a statistically significant difference between two groups regarding the amount of HbA1C (p< 0. 000) and Insulin level (p= 0. 02). According to the results، using this model in Diabetic adolescence for controlling Metabolic is recommended.

If not done properly، suction causes complications such as hypoxia، cardiac arrhythmias or even death. Suction is being used in most hospital wards. Closed Suction appears to have fewer side effects، although studies have reported dissimilar results. The aim of this study was to compare the effect of open (control) with closed (test) endotracheal suctioning on patients’ Hemodynamic state. This study was a randomized clinical trial in 86 patients admitted in the ICU of Besat hospital of hamedan in 2013، being divided into two groups: open (control) and closed (test) endotracheal suctioning. Systolic and diastolic blood pressure، mean arterial pressure (MAP)، heart rate، arterial O2 saturation (SPO2)، respiratory rate and the incidence of disrrythmia were recorded in patients´ questionnaires immediately، and afterwards 2 and 5 minutes after endotracheal suctioning by open and closed methods. Data analysis was performed by Repeated Measure ANOVA، t test، chi-square and Fisher''s exact test. A total of 102 patients were included in the study. Sixteen patients were excluded from the study and data from 86 patients were analyzed. No statistically significant differences in age (15/0P =) and sex (33/0P =) were found between the two groups. Hemodynamics index in two groups was similar before the suctioning (P >0. 05). In the open group، there was an increase in diastolic blood pressure (P=0. 017)، mean arterial pressure (P=0. 019)، heart rate (P=0. 003) and respiratory rate (P<0. 0001) immediately، 2 and 5 minutes after suctioning in comparison to the closed group (P>0. 05). Systolic blood pressure، SPO2 and incidence of disrrythmia were similar in the two groups. Endotracheal suctioning by closed method had lower effects on patients´ Hemodynamic status rather than the open system. Hence، closed endotracheal suctioning is recommended in the ICU.

Proposing an appropriate model of feeding behavior to mothers plays an important role in creating an accurate child feeding conduct. Studies have shown that mothers have low level of knowledge and practice regarding their childrens’ nurishment. Newsletter is an educational media providing families with easy access to information resources. Group discussion is one of the best ways to change behavior. This study aimed to compare the effects of training mothers by either newsletter or discussion groups in nutritional quality of preschoolers. In this study، 192 mothers having preschoolers were selected by a convenient method and randomly assigned to discussion، newsletter and control groups. A newsletter was sent for 4 weeks. The discussion group was trained with similar educational content one hour per week. Data were collected immediately after the intervention and then one month later using a Healthy Eating Index (HEI). Data analysis was performed with Repeated Measurements. Context validity index and test re-test (r=0. 82) was used. There were no significant differences before the intervention، and between the HEI (Healthy Eating Index) score groups. HEI scores after education and one month later were significantly higher in the discussion and newsletter groups compared to control group (p<0. 001). No significant difference was found between the discussion and the newsletter groups regarding HEI score after education and one month later (p>0. 005). Effect of maternal training with newsletter and group discussions on children’s nutritional quality was equal. Given the ease of use of newsletter as an effective alternative method، it can be utilized in preference to group discussions.