فصلنامه پرستاری قلب و عروق
سال دوم شماره 3 (پیاپی 7، پاییز 1392)

The aim of this study was to determine the effect of patient teaching on self-care behaviors with media clips in patients with permanent pacemaker. One of the most common causes of death after myocardial infarction is arrhythmia. One of the methods to control the arrhythmia resistant to treatment is implantation of pacemaker. The studies that have been done on patients with electrical devices show that most of patients don’t have any information about how to take care of their device and need more education for self-care. This randomized clinical trial was conducted on 80 patients scheduled to receive permanent pacemakers at Rajaie Cardiovascular, Medical and Research Center in 2012. The patients were recruited to either control or intervention group through block randomization method. Data were collected using demographic checklist. The intervention group patients together with one of their close family members received one session of self-care education on the pre-implantation day. The session was 30 minutes long and contained the use of educational media clip. At the end of the session, the patients were given an “educational package”. Following implantation, the intervention group were contacted weekly for a one-month period. Finally, the variables were compared between the two groups via independent t-test, chi-square test, repeated variance analysis, and using SPSS version 15. There were no statistically significant differences between the intervention and control groups (P=0.106); however, after intervention, a meaningful difference was observed in all these variables in the intervention group (P<0.0001). The results of this study showed that education of self-care behaviors with media clip could have an impact on the self-care of post-pacemaker implantation patients; and we recommend this method to improve patient’s knowledge and self-care behaviors and minimize the number of re-hospitalization in these patients.

The aim of this study was to assess the effects of concurrent aerobic-resistance training on Hs-CRP and body composition in sedentary middle-age men. Cardiovascular diseases (CVD) are the primary cause of death and disability in both men and women worldwide. Moreover, it has been shown that high sensitivity- C-reactive protein (Hs-CRP), as a marker for future cardiovascular events, has an inverse relationship with physical fitness in sedentary individuals. However, it is suggested that lifestyle modifications such as regular physical activity have therapeutic and protective effects against CVD. Thirty sedentary middle- aged men (aged 30–50 years) voluntarily participated in this research and assigned in one of experimental (n=15) and control (n=15) groups. Participants in experimental group performed the progressive concurrent training, three days a week for eight weeks. At baseline and after 8 weeks, venous blood samples were obtained to measure Hs-CRP concentration. Moreover, body composition and anthropometric indices (weight, body mass index, waist circumference, waist to hip ratio, body fat percentage) were measured. Data were analyzed by using paired and independent t-tests. After 8 weeks of concurrent training, a significant decrease was seen in serum Hs-CRP in the experimental group compared to control group (p<0.05). Moreover, the concurrent training induced a significant decrease in body weight, body fat percentage, body mass index, and waist to hip ratio (p<0.05), while these parameters remained unchanged in the control group. According to this study, 8-week concurrent exercise training resulted in beneficial improvement in body composition and HS-CRP. Accordingly, it can be concluded that they can be effective therapeutic methods to reduce cardiovascular risk factors in sedentary middle-age men.

The purpose of this study was to assess the relationship of nutrition knowledge and physical activity level with total cholesterol, high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) in men with myocardial infarction (MI). Myocardial infarction is the most common cardiovascular disease and considered as the main cause of mortality in the world including Iran. The studies show modification of unhealthy lifestyle is a preventive method in cardiovascular diseases.Nutrition knowledge and physical activity are important factors in reducing serum lipid levels and prevention of cardiovascular disease, particularly myocardial infarction. Modification and promotion of nutrition knowledge and physical activity levels in individuals with history of cardiovascular disease may reduce the risk of myocardial infarction. This is a quasi-experimental study in which 150 men from Milad Hospital in Tehran (mean age of 58.01 with standard deviation of 3.58 years, mean weight of 80.8 with standard deviation of 13.18 Kg, and mean height 174.24 cm with standard deviation 6.43 cm) were selected by Morgan table to fill two questionnaires of nutrition knowledge (Wardle 1999) and of physical activity level. After 12 hours fasting, HDL-C, LDL-C and total cholesterol levels were measured in all subjects. The data was analyzed in the significance level of 0.05. The findings showed that there was a statistically significant correlation of nutrition knowledge and physical activity level with LDL-C and total cholesterol in adult men with MI, but no significant correlation with HDL-C was found. According to the results, with promoting nutrition knowledge and physical activity level in men with MI, the risk of cardiovascular diseases (especially myocardial infarction) can be controlled.

This study aimed to explore the effectiveness of storytelling technique on professional communication skills of nurses in critical care units of ShahidRajaee Heart Center. Patient Communication skill is one of the most important aspects of nursing profession that can improve the overall abilities of nurses and health care team. Sharing the tacit knowledge on patient communication skills is one of the issues with which nursing system encountered. Retirement of experienced nurses causes a considerable loss of tacit knowledge. One of the best ways to transfer tacit knowledge is to apply the storytelling technique in transferring these experiences. This was a quasi-experimental study with control group. It was conducted on 130 nurses, working in the ICU, who were randomly divided into groups of intervention and control. The intervention group was instructed via storytelling on clinical experiences within 6 hours. The effect of the intervention was tested through a self-reflective questionnaire completed by both groups before the intervention and one month later. To analyze the data, paired and independent T-test, Chi-square, Fisher exact test, Mann-Whitney U test and the analysis of covariance via SPSS version 21 were applied. Results showed that the intervention and control groups` pre-test scores were 104.60 with standard deviation of 7.60 and 103.13 with a standard deviation of 9.60, respectively. Furthermore, their post-test scores were estimated as 117.92 with a standard deviation of 4.37 and 102.25 with standard deviation of 8.66 accordingly. There was a statistically significant difference between the post-test scores of intervention and control groups regarding their professional communication skills (p< 0.001). According to the sample based effect sizes, 71.4% of the variability in the post-test is caused by the intervention. Based on the findings, it can be concluded that storytelling technique enhances the clinical competency of nurses in terms of professional effective communication with both patients and colleagues. Therefore, this technique can be introduced as an effective way to promote professional communication.

The aim of this study was to describe and interpret the life experience with heart transplantation. Part of the findings was about spiritual development of heart transplant recipients which is reported in this article. Heart transplantation is one the recent medical innovations that leads to increase in recipients’ life expectancy and quality of life; however, these people will face some problems and need to have supported resources. This study was a qualitative study with phenomenology approach. Participants were 11 heart transplant recipients in Iran.The data was collected through semi-structured interview and analyzed with Dickelmann, Allen and Tanner method. One of the main concepts of this study was approaching to God including "trust to God", "belief in destiny", "further belief in God", and "restricted religious rituals" which indicates the spiritual development. Heart transplant recipients experience high level of spiritual and religious status which help them to overcome hopelessness, unpredicted problems and heart transplant consequences by trusting God.

The purpose of this study was to determine the effect of comprehensive-care program on patient satisfaction in patients with minor and moderate trauma (accident, fall and other types of trauma) in emergency department. Assessment of patient satisfaction is one of the most important indicators of measuring quality of care. Patient satisfaction of nursing services is declining it can be caused by increased awareness of patients about their rights and health care services which leads to an increase in patient expectations of health care services. Comprehensive care program is one of the ways to increase patient satisfaction. This clinical trial study was conducted with 104 patients, 52 in each control and experimental groups. The experimental group received comprehensive-care program from the moment of entering emergency department to the discharge of emergency department and the control group received the usual nursing care. After implementing comprehensive-care program and at the end of the patient stay, the patient satisfaction in two groups was measured using a modified form of satisfaction questionnaire. The data analysis was done by SPSS software, version 22 using descriptive and inferential statistics. The mean score of the total satisfaction was 32.02 (relatively appropriate) and 45.6 (appropriate) after intervention in control and experimental groups, respectively. There was a statistical significant difference between the mean score of total satisfaction of the groups after intervention (p<0.001). Implementing comprehensive-care program increases the rate of the patient satisfaction. Therefore, it is recommended to managers and staff of the health care centers and educational centers to apply comprehensive care program.

The purpose of this review of article is to assess the reuse of angioplasty devices as a challenge to the health center. Processing and reuse of disposable medical products began in the United States in 1970. Nowadays, infection is one of the common post-operative complications which have different severities and types based on social, financial and cultural conditions in different countries. Ignoring the proper disinfection and sterilization of hospital devices and equipment is one of the most important sources for distribution and transmission of nosocomial infections. The papers from 1998 to 2013 were searched for based on the key words "Reuse", "Single Use Only", "Disposable", "Medical Equipment", and "Reuse of Single Used Devices (SUD)" (alone or in combination) in Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, Medline, EMBASE, and PsycINFO. The main problems in reusing angiography devices include the failure in cleaning, disinfection and sterilization of equipment due to structure design, lack of knowledge and not providing information to patients and families regarding to reuse of disposable devices, unclear cost for the equipment, ambiguous disinfection and sterilization techniques for disposable medical equipment due to lack of proper staff supervision, lack of informed consent for reusing equipment, contradiction to the principles of clinical governance, patient safety, JCI standardization, and negligence of the ethical issues of patient care. According to the lack of efficient reprocessing the angiography devices in country, lack of official license and policies issued by Ministry of Health and the Center of Medical Equipment, and the above mentioned risks, the reuse of these devices is not recommended.

The aim of this study was a review on common pain assessment tools which are used in critical care units. Pain is an unpleasant physiological and psychological feeling and a complex phenomenon which is common among patients in critical care units. Nowadays, the importance of pain is to the extent that the American Pain Association named it as the fifth vital sign. Pain relief is an important issue to improve patient outcomes in the intensive care units. Accordingly, nurses must be sensitive in precise pain assessment. In this review article, six pain assessment tools were selected based on the keywords "pain", "pain relief", and "pain assessment tools" from the databases Ovid, PubMed, Cochran, CINHAL, Science Direct, Scopus, and Google Scholar. Among articles on pain assessment tools, 40 articles were selected. There are six commonpain assessment toolsused in critical care units includingCritical Pain Observation Tool (CPOT),Behavioral PainScale(BPS), behavioralpain assessmenttool(FLACC), Non-VerbalPainScale)NVPS), Pain Assessment and Intervention Notation (PAIN) algorithm and Nonverbal Pain Assessment Tool (NPAT) which are used in adult and pediatric patients with verbal impairment and for painfulprocedures. According to the importance of pain management in intensive care units, nurses must particularly apply valid tools for pain assessment to facilitate healing process and use of pain medications properly.