نشریه پرستاری مراقبت ویژه
سال هفتم شماره 1 (پیاپی 22، بهار 1393)

Patients in intensive care units experience many physiological and psychological complications that their recovery sometimes takes several years. Life quality of intensive patients after discharge is lower than other internal and surgical patients and physical problems makes a person disable in doing daily activities. This study assesses the effect of using self-help rehabilitation program on the life quality of the patients discharged from Intensive Care Units. It was a clinical trial study which was done on ninety patients of internal-surgical intensive units of three hospitals in Kerman. This study was done by SIP68 life quality questionnaire with three physical، psychological and social areas and six dimensions in 2012. After patients’ discharged from intensive care unit، they were in a general ward in tow case and control groups، data were analyzed by using inferential، descriptive statistical tests and SPSS19 software. The mean score of the life quality in all the dimensions in intervention group was improved statistically. The mean age of the participants was 37. 2 (9. 5). 44. 99 percent (50. 73) were women and 45. 54 percent (49. 26) were men. There was no relationship between none of the demographic factors and life quality. Since intervention had remarkable effect on improvement of the patients’ life quality after discharge، performing patient-centered methods is effective in this area.

Many patients hospitalized in CCU experience reduced quality of sleep. One of the methods for treating sleep disorders is using complementary medicine such as acupressure. The purpose of this study is “investigating the effect of acupressure on the quality of sleep in patients with Acute Coronary Syndrome (ACS) in CCU”. This is a two-group double blind clinical trial study which was conducted on 60 patients with Acute Coronary Syndrome (ACS) in Mazandaran Heart Center in 2013. Samples were selected from statistical available population and were randomly assigned in two groups. The group of acupressure received bilateral acupoint massage from the second night of hospitalization for two minutes during three nights، in every point it was totally 18 minutes. Patients in the control group received massage on these points with the same technique and time with 1-1/5 cm distance from the main points. The quality of patients’ sleep was completed with SMHSQ hospital sleep questionnaire. Findings were analyzed by SPSS 18 statistical software and K2، independent test، ANOVA (analysis of variance) repeated measures statistical tests. There was significant difference between sleep quality of the patients in acupressure group and control group which was also statistically significant (p <0. 05). This study showed that acupressure can have therapeutic effect in improving quality of sleep in ACS patients. Therefore this method can be taught to nurses who have an important role in the identification and elimination of patients’ sleep disorder and also it should be taught to the patients themselves and their companions.

pain due to the removal of the chest tube is one of the important complications after open heart surgery. In the case of inadequate pain management، sympathetic system is stimulated and can lead to irreversible complications. Studies showed the effect of reflexology massage on pain relief in other cases; so this study had been done with the aim of “determining the effect of foot reflexology on the pain of the patients under open heart surgery during chest tube removal.” this randomized clinical study with control group was done in the hospitals covered by Baqiatallah Medical Sciences University in 2013. Ninety samples were divided into three experimental، control and placebo-treated groups based on randomized allocation. Pain level was measured through Numerical Rating Scale (NRS) in all the three groups before intervention. In the experimental group center of the anterior one-third and in the placebo-treated group، Posterior one-third of the left foot was being massaged for ten minutes before chest tube removal. There was no measurement in the control group. After removal of the chest tube، the level of the pain was measured and documented immediately. Data were analyzed by SPSS 18 software by the help of descriptive and inferential statistic. difference in the average of the quantitative variables including; age، height، weight and level of the body and demographic qualitative variables of the patients including; education status، occupation and marital status was not significant (P>0. 05). Expected increasing of the pain due to the chest pain tube removal was not significant in the experimental group (P=0. 08)، while placebo-treated and control groups had significant increase of the pain (P=0. 001 and P=0. 000 respectively). foot reflexology massage is a useful nursing intervention in chest tube removal after open heart surgery. This intervention improves care level of the patients in the important recovery phase after open heart surgery with the least cost and without any complications.

Evidence-based nursing guidelines are important tools in increasing the quality of nurses’ clinical work. Assessment of patient’s satisfaction is one of the most important indicators of measuring quality of provided care to patients. This study has been done with the aim of determining the effect of evidence-based nursing guidelines implementation onsatisfaction of the patients with acute coronary syndrome hospitalized in coronary care unit (CCU). This two-group clinical trialstudy wascarried out in Hazrat Fatima (SA) hospital in Kerman on 90 patients in 2014. Before and after implementation of guidelines education program، patients’ satisfaction rate was measured by patient’s satisfaction standard instrument (PSI) and data was evaluated by SPSS 19 statistical software and by using mean and standard deviation descriptive statistics and t-test and chi-square inferential statistics. patients’satisfaction before intervention، with mean score of 104. 2 (9) was in moderate level and after intervention، with mean score of 116. 4 (52) was in good level of satisfaction p=0. 000. evidence-based nursing guidelines implementation improved patients’ satisfaction regarding nursing care. Therefore it is suggested to the officials and managers of hospitals and educationalcenters of health-treatment services to put evidence-based nursing guidelines education in their agenda.

Prematurely birth of the infant and his/her hospitalization in NICU is something really unexpected for the parents. In most of the cases fathers are the first visitors of the infant in NICU and they are counted as the key person in supporting mother and infant. Lack of supporting father and shortage of his awareness increase his stress in this crisis and have some inappropriate short-term and long-term outcomes. The aim of this study is assessing the effect of a designed program about the intervention of family support on the stress of the fathers of premature infants hospitalized in NICU. In a two-group semi-experimental study which was done in 2013، fathers of fifty premature infants hospitalized in NICU of Shahid Beheshti hospital in Isfahan were chosen through convenient sampling and were divided into two control and experimental group. Family supporting program was a two-phase program. The first phase included two informational and one observational sections and the second group included supporting section. Parental stress measurement questionnaire in both of the groups was completed by the infant’s father in two before and after time of intervention. For analyzing information SPSS 18 software and descriptive and inferential tests were used. In the experimental group there was significant difference in the average of scores before and after intervention in two subscales of “appearance and behavior of the infant and special treatments” and “the relationship of the parents with the infant and acceptance of parental roles” and the average of total score، while this difference was not significant in control group in none of subscales of parental stress and total score. Before intervention، there was no significant difference between the two groups in terms of the average score of parental stress in three subscales of parental stress and total score; but after intervention in experimental group، the difference of the average of the parental stress scores in two subscales of infant’s appearance and behavior and special treatments and the relationship of the parents with the infant and acceptance of parental roles and total score was significantly less than control group. Emotional-informational support program could decrease stress level of the fathers of premature infants hospitalized in NICU، so appropriate effort and policies can be valuable in paying more attention to the father and his partnership.

By better understanding of trauma epidemiology and its confounding factors، appropriate strategies and programs including using preventive measures and organizing the delivery of services can be adjusted and quality of cares related to trauma can be improved. The aim of this study was to determine trauma epidemiology and its associated factors in Guilan. in a cross-sectional study، 577 patients with traumatic damage who were transferred by pre hospital emergency to Out Patient and Emergency Department (OPD&ED) of Poursina medical-educational center in Rasht were chosen by convenient s ampling and by using a researcher-made record form in three shifts (morning، evening and night) in 2013. Data analysis was done by t-tests، one-way ANOVA and Chi-square. The majority of samples (82. 7%) suffered from traumatic damages due to car accidents and disturbance of this trauma in men was 3. 5 times higher than women. The mean age of the people was 35. 17 years old and the maximum age group was 20-29 years. (67. 6%) were the blunt trauma. The main road was the place where trauma was mostly occurred in them (71. 8%) and most accidents happened out of the cities (89. 9%). Majority of crash cars were light vehicles (48. 5%). Revised of trauma score (RTS) in majority of samples (76. 6%) was12. (29. 8%) and (28. 1%) were respectively drivers and passengers. The maximum amount of the accident was at 5 p. m. There was significant relationship between mechanism of trauma and age (p<0. 02)، RTS (p<0. 008)، trauma`s place (p<0. 01) and position of victims at the scene (p<0. 00). Also there was significant relationship between type of trauma and age (p<0. 02)، sex (p<0. 00)، RTS (p<0. 00)، trauma`s place (p<0. 006) and the position of the victims at the scene (p<0. 01). Traumatic damages can be reduced by recognizing trauma associated factors، improving road traffic، public education for paying more attention to traffic rules and other procedures for preventing injuries.

The aim of intensive care units of the hospitals is decreasing mortality rateand improving health of the society. This study was done with the aim of “studying and comparing the performance of intensive care units by determining mortality rate and finding its relationship with structural situation of these units”. This cross-sectional study was done during six months in 2011 in the intensive care units of educational hospitals inHamedan. The study was done on 200 patients through convenient sampling in the intensive unit of Besat hospital and in two intensive care units of ShahidBeheshti hospital. Data collection tools included SAPS3 checklist that its validity and reliability were confirmed in different studies and a researcher-made structural standards checklist in three areas (human force، physical environment and medical equipment). The ratio of the actual death to the expected death (SMR: standardized mortality rate) was determined by SAPS3 and its relationship with the structural standard score was measured. For data analysis، Kruskal-Wallis، Mann-Whitney، chi-square and Spearman correlation coefficient and SPSS17 software were used. Based on the SAPS3 scoring system، the ration of the actual death to the expected death (SMR) was more than one in all the units of the study which means weak performance; in a way that SMR of Besat، Ghaem and Milad units were respectively; 2. 29، 1. 38 and 1. 56. Structural situation score of the units of the study were also less than 50% of the standard in a way that Besat، Ghaem and Milad units had respectively 48%، 45% and 41% of the structural standards scores. There was no significant relationship between structural standards scores of the units of the study and their SMR performance score (p=0. 66). Performance score of all the three units was weak and regarding structural standards the mentioned units were less than moderate. It is necessary to try to improve structural standards and to decreaseratio of the actual death to the amount of deathexpected by managers، physicians، nurses and other staff of the intensive care units.

Anemia is one of the main problems in hemodialysis patients which causes by inadequate production of Erythropoietin. Functional iron deficiency anemia is a kind of anemia which leads to resistance and inappropriate response to Erythropoietin in hemodialysis patients. Since early diagnosis of this anemia is important before Erythropoietin usage، this study was conducted to determine p revalence of functional iron deficiency in hemodialysis patients. In a cross – sectional descriptive study studied 184 CKD patients referred to hemodialysis units in Baqiatalla and Chamran hospitals in the Tehran city. In order to information collecting plus to completing the demographic questionnaire were measured Serum Hb، Hct and Ferritin levels. In order to data analyze making use of SPSS software and Chi square، t، Fisher and ANOVA tests. Anemia was observed in 37% of patients. The mean of serum levels of Hb was 10. 98±1. 66 g/dl and Hct was 34. 1±5. 16%. 41. 1% of patients suffers of functional iron deficiency and Hyperferritinemia exists in 80. 4% of them. Functional iron deficiency is seen in about half of hemodialysis patients and can cause resistance and inappropriate response to Erythropoetin in hemodialysis patients. Therefore before administration of erythropoietin recommended determining the status of iron stores until prevent of therapeutic heavy costs imposition.