نشریه پرستاری مراقبت ویژه
سال هفتم شماره 3 (پیاپی 24، پاییز 1393)

Considering the importance of correct documentation in taking care of the patients especially in Coronary Care Unit (CCU), this study aimed at explaining nursing documentation requirements in CCU for improving the reporting system.

It’s a qualitative content analysis study, 15 qualified nurses and 15 qualified instructors from Iran were selected through purposeful and snowball sampling method in 2013. They explained documentation requirements in the CCU by using open-ended questionnaire. One note software was used for data analysis.

After data analysis, 22 subcategories from 5 main categories were emerged as documentation requirements in CCU: (1) health history, (2) health evaluation, (3) monitoring, (4) nursing interventions, and (5) nursing discharge notes.

On admission information regarding health history, findings achieved from patient’s health assessment in different situations such as; a. at the beginning of admission, b. at the beginning of every shift and c. Discharge time, also information achieved from patient’s monitoring during shift; nursing interventions done for the patient and discharge time report are counted as nursing documentation requirements in (CCU).

Anxious is very common among patients undergoing Coronary Artery Bypass Graft (CABG) surgery and it has significant effect on recovery process and following up treatment. The most important factor regarding treatment of anxiety is faith and religious affiliations. This study is conducted to assess the impact of spiritual care based on a Ghalb-e Salim (good heart) model in reducing anxiety of patient’s candidate for CABG. In this clinical trial study, 60 patients candidate for CABG were selected in Baqiyatallah (AJ) hospital in Tehran in 2013. These patients had moderate and sever anxiety score and they were divided into two experimental and control groups. Spiritual care based on Ghalb-e Salim model was done through educational booklet and direct education during hospitalization in experimental group. Beck Anxiety questionnaire was completed by the patients in three stages; during hospitalization, before surgery and before discharge; information was analyzed by using SPSS20 software and descriptive and inferential statistical tests. The preoperative anxiety in the experimental group was significantly reduced (9.8±3.5); it is while preoperative anxiety of patients had a significant increase in the control group (37.7±11.71). totally, based on independent t statistical test, anxiety was reduced after intervention (p=0.000) The Mann-Whitney test showed that there was no significant difference between the two groups in terms of anxiety levels on admission, but preoperative anxiety levels in the experimental group and the control group were respectively in the moderate (40 %) and severe (80 %) level (p=0/001) Spiritual care based on Ghalb-e Salim model was taken from Islamic statements and they are effective for organizing spiritual cares in nursing and reducing anxiety of the patient’s candidates for cardiac surgery.

Today a large number of patients hospitalized in Intensive Care Unit need mechanical ventilation via an artificial air way. Since these patients have endotracheal tube, endotracheal suctioning is necessary for increasing oxygenation, cleaning the airway and keeping it open. But this method consists of various side effects such as increased blood pressure and heart rate and respiratory rate, cyanosis, dizziness and increased intracranial pressure and hypoxia. This study aimed at comparing the effect of using normal saline serum, N-acetyl cysteine and not using them in endotracheal suctioning on physiologic parameters and the amount of secretions in intubated patients under mechanical ventilation. It was a controlled clinical trial study with random allocation that was performed on 54 intubated patients hospitalized in ICU of health educational centers of Babol Medical Sciences University in 2014. Endotracheal tube suctioning was performed for each patient once without saline, the second time with 3 ml of normal saline and the third time with 2 ml of N-acetyl cysteine. Blood pressure, Heart rate, Respiratory rate, Arterial oxygen saturation were measured and recorded before each stage of suctioning and two and five minutes after that. Amount of secretions was measured after each method of suctioning. Data were analyzed by SPSS16 statistical software, variance analysis with repeated measures, ANOVA and paired t statistical tests. Blood pressure, Heart rate and Respiratory rate were increased after suction in all the three groups, but these changes were higher in the group that received normal saline. Average decrease of Arterial oxygen saturation was more in the method of receiving normal saline (p<0.05). The amount of secretion was more ​​ in the method of receiving N-acetyl cysteine (p=0.004). Endotracheal tube suctioning by using normal saline had more adverse effects on post- suction physiological parameters in compare with the other two methods. Therefore, it is recommended to not use normal saline in endotracheal tube suctioning to the possible extent, and if removing secretions is required, endotracheal N_ acetyl cysteine ​​ should be used according to the patient's condition.

Lack of facilities, experienced teachers and choosing appropriate teaching method have always been among the challenges of holding CPR courses. The aim of this study was determining “the effect of multi- media educational software on learning basic principles of Cardio-Pulmonary Resuscitation (CPR) in nursing students”. This is a quasi- experimental study which was conducted in 2013. The study population included 70 nursing students in fifth and sixth semester of Islamic Azad University of Karaj. The samples were divided into two lecture and practical training (35) and multi-media education and practical training (35) groups through blocked random method. Theoretical education of CPR basic principles was done by lecturing in the first group and by multi-media educational software in the second group. Practical training was done similarly in both groups through 2 sessions working on mannequins. After a week, written exam was taken from the both groups by using basic life support skills questionnaire and after two weeks, practical test was taken based on the standard checklist and also Objective Station Clinical Evaluation (OSCE). Data was analyzed in SPSS 18 software by using independent t-test, chi- square and Mann-Whitney U. The knowledge mean score in the intervention group (16.20±2.02) was significantly higher than the control group (12.57±2.60) (p<0.001). In the scope of practice, there was no significant statistical difference between the two groups in the practical areas of patient’s assessment (p=0.056), opening the airway and respiration (p=0.13) and cardiac massage (p=0.36). The results of the present study indicated that providing content in the form of multimedia software can improve nursing student's knowledge more than lecturing and simulation, but it is not effective in improving student's psychomotor performance. Therefore, using objective methods and clinical education are recommended for improving CPR psychomotor skills.

Most of patients that refer for angiography do not have enough information about the procedure; this lack of knowledge makes the patients dissatisfied. Accordingly the aim of this study was investigating the effect of video education based on patients’ native language on knowledge and satisfaction of patients hospitalized for coronary angiography. In This quasi experimental study, 160 patients were randomly assigned into two control (n=80) and experimental (n=80) groups. These patients were selected among all the patients who came for non-emergency coronary angiography for the first time in the Thoracic Department of Medical-Educational Center of Imam Khomeini in 2013. For the experimental group, an educational film about the coronary angiography was presented. And for the control group, the routine actions of the ward were presented. The awareness level of the patients in both groups was measured after and before education by using a researcher-made awareness questionnaire. And the satisfaction level of the patients in both groups was measured after education by using a researcher-made satisfaction questionnaire. Data was analyzed by SPSS13 software with using chi-square test, independent t-test and paired t-test. After the intervention, the mean of satisfaction in the experimental and control groups was respectively; 41.20 and 23.95 and the mean of awareness was respectively; 15.81 and 6.81; the experimental group in both dimensions (p =0. 001) was better than the control group. Results of this study confirm the efficiency of video education based on patients’ native language in increasing knowledge and satisfaction of the patients candidate for coronary angiography. Therefore, the video education is recommended for educating these patients.

patient’s satisfaction has been attended as an important criterion for studying performed cares in recent decade. Achieving such aims should be based on using a valid tool and aboriginal culture. So this study had been done with the aim of designing and measuring validity and reliability of the tools for measuring parents’ satisfaction that have a hospitalized infant in Neonatal Intensive Care Unit (NICU) about hospital services. in this methodological study, firstly initial tools have been designed with 60 items according to literature review. Then content and face validity had been provided through quantitative and qualitative study (CVI and CVR) and construct validity had been done in this way that by doing exploratory factor analysis, 300 parents with hospitalized patients had been chosen during cluster sampling from chosen state hospitals of Tehran in 2013. Reliability had been assessed through internal consistency. final questionnaire had been approved with 49 items in three areas of welfare services, nursing cares and medical cares. In the results of exploratory factor analysis, KMO sampling index was 0.945. Also Bartlett test of Sphericity with 12593.822 in the level of 0.0001 was significant. Reliability has been approved by α=0.96. considering that all validity and reliability indexes of the questionnaire are reported in an appropriate level, infants’ parents’ satisfaction questionnaire can be used as a valid and reliable questionnaire in measuring infants’ parents’ satisfaction, hospitalized in NICU.

Considering the increasing rate of hemodialysis patients, different results of previous studies, human’s constant interaction with the environmental changes and living in today’s modern world, people are exposed to a barrage of constant changes and stressors. These changes in chronic renal failure patients comparing to healthy individuals are more and different. The type of coping strategies used by the people depend on several factors including personal experience, social support systems, personal beliefs, available resources and genetic background. The study aimed to “identifying the type of experienced stressors and coping strategies used by hemodialysis patients”. Mothods: In this descriptive correlational study, Hemodialysis Stressors Scale (HSS) and Jalowiec Coping Scale (JCS) were used to investigate stressors and coping strategies of 70 hemodialysis patients hospitalized in hospitals supervised by Medical Sciences University of Jiroft in 2013. Sampling was done through census sampling method. Data analysis was done by SPSS 20 software, the methods of descriptive and inferential statistics of chi-square type and Fisher's exact test with 95 % Confidence Coefficient. The majority of samples (48/6%) were from 41 to 60 years old and 60 % of them were male. 11/4 percent of them experienced physiological stressor and 88/6 percent experienced psychosocial stressors. Therefore psychosocial stressors were reported more bothering than physiologic stressors and patients experienced them more. Optimistic coping mechanism was the most common coping strategies used by the patients. The most frequent experienced physiological stressors included fatigue, limitations of fluids, limitations of food and arterial & venous stick and the most frequent psychosocial stressors included limits on the time & place for vacation, boredom, sleep disturbances and interference with job. There was statistically significant relationship between the percentage of experienced stressors in hemodialysis patients and their age (p=0/005). Since psychosocial stressors were reported more bothering than physiologic stressors by the participants, decreasing or balancing them seems so essential. Being familiar with the experienced stressors and the amount of usage and effectiveness of the used coping strategies can help to provide appropriate programs to facilitate adaptation and acquiring necessary skills for patients and their families.

Cardiovascular diseases is one of the main causes of mortality in the world. Coronary Heart Disease (CHD) is one of the cardiovascular diseases that influence patients’ quality of life. Evaluating quality of life of these patients is one of the components of treatment; this study is done with the aim of comparing patients’ quality of life before and after CABG. This cross-sectional study was conducted on 90 patients candidate for CABG in Baqiatallah and Jamaran Heart hospitals of Tehran in 2013. Sampling was done among the patients who had the inclusion criteria through convenient sampling method. Collecting data was done before and two months after surgery; MacNew specific Questionnaire of heart patients’ quality of life was used for this purpose. Paired t-test and SPSS17 software were used for statistical analysis. The average score for quality of life before and two months after surgery was respectively 225.4 (24.88) and 168.6 (34.7). Also quality of life had significant decrease before surgery in compare with after surgery regarding emotional, physical and social dimensions (p<0.001). Quality of life will be decreased in a short period of time due to surgical complications. Conducting longitudinal studies is recommended for more accurate assessment of this concept.