Modern Care Journal
Volume:11 Issue: 2, 2014

Patient education has a fundamental role in control and improvement of diseases. T his study aimed to investigate the impact of implementing the Six Sigma model on the quantity and effectiveness of patient education in the CCU of Vali-asr Hospital in Birjand. In this quasi-experimental study, 56 patients who were admitted in CCU during 1.5 months were taken as the control group and taught by the conventional method. Awareness and attitude were measured at the time of admission in, and discharge from, the ward, and the quantity of patient education was measured at the time of discharge. T hen, Six Sigma model was applied for nurses in group discussions and interviews, and nurses tried to educate patients based on the solutions obtained in the discussions. All patients (n=47) who were admitted in the hospital during the coming 1.5 months were taken as the case group and evaluated by the same methods and tools. Data were collected using a researcher-made questionnaire whose validity and reliability were confirmed. Data were analyzed in SPSS (version 18) using independent t-test and paired t-test. Results revealed that quantity of patient education increased significantly more in the case than the control group (P<0.001). The overall awareness score mean and its areas, and attitude score of patients in the case group increased significantly on the day of discharge vis-à-vis admission (P<0.001).However, no significant difference occurred in the control group. Results show a significant increase in the quantity and quality of education to patients after the implementation of the Six Sigma model. Thus, patient education can be promoted by recognizing the existing processes, their roots and defects, and by modifying the processes.

Breast cancer is the most common malignancy in women whose diagnosis, complications, and physical and psychological alterations due to treatment affect body image. The aim of this study was to determine body image and the associated factors among women with breast cancer. In this analytic, cross-sectional study, 170 breast cancer women who had inclusion criteria were selected through sequential sampling method from educational and therapeutic hospitals in Rasht. Body Image Scale and a researcher-made questionnaire of demographic, social and health-related issues were used to collect data. The data were analyzed in SPSS (version 16) using Independent T Test, ANOVA, Pearson, Regression, Mann-Whitney, and Spearman tests. The majority of married individuals had undergone mastectomy. The mean age of participants was 50.67 ± 10.04, mean duration of disease diagnosis was 1.9±0.8 years, and the body image mean score was 8.6 ± 5.38. Results indicated that there was a significant relationship between the duration of disease diagnosis, type of breast surgery, duration of time after surgery, duration of time after chemotherapy and radiotherapy, and body image. Also, there was a significant relationship between body image, surgery type and the duration of disease diagnosis with multiple regression (P<0.0001). Insights from the present study along with comprehensive psychological examination of patients can effectively contribute to elevating care quality, preventing psychological disorders, and improving body image among women with breast cancer.

Proportional to the etiology of depression among cancer patients, various treatment methods are known one of which is dialectical behavior therapy. This study investigated the effectiveness of group dialectical behavior therapy on decreasing depression level of patients with cancer. In this quasi-experimental study with pretest, posttest, and control group, 26 of cancer patients who referred to the chemotherapy centers in Shiraz in 2012 were selected through available sampling method and randomly divided into case and control groups. The case group participated in 16 ninety-minute sessions of dialectical behavior therapy, while the control group did not receive any treatment. The data collection tool was Beck Depression Inventory (BDI-II) whose reliability was determined 0.92 according to Chronbach's alpha. The data was analyzed in SPSS (version 18) using paired t-test and covariance analysis at the significant level P=0.05. The results showed that the case group's mean depression score decreased from 14.11±4.4 to 5.92±3.87 which is statistically significant (P<0.001). No significant difference was observed in the control group. Findings of the study indicate that dialectical behavior therapy can reduce depression among cancer patients. Therefore, this finding can be used for planning on the basis of cognitive theory or for preventing and reducing depression among cancer patients.

A ll nurses need continuing education, especially those working in oncology wards. In the current programs, there are just two general patterns for teaching: teacher - centered and student - centered patterns. T he aim of this study was to compare the effect of teacher -centered (lecture) and student-centered (module) teaching methods on the knowledge and practice of oncology nurses in relation to safety standards with cytotoxic drugs. In this quasi-experimental study, all the nurses in Shiraz (2010-2011), who participated in the prescription of cytotoxic drugs to patients were selected (n=86) and randomly divided into three groups. The module group (n=29) used a self-directed module, the lecture group (n=28) was taught by an experienced lecturer in the classroom for 5 hours, and the control group (n=29) did not receive any intervention. Data in relation to knowledge and practice of oncology nurses in the three groups were collected before and 8 weeks after the intervention using a researcher-made questionnaire and checklist. To analyze the data, paired t-test, Chi-square, one-way ANOVA, and Tukey test were used at 0.05. Knowledge and practice mean scores increased significantly from baseline in both intervention groups (P<.001), but there was no significant difference between the scores for the control group (P>0.05). Change of knowledge and practice mean scores in lecture and module grous was significantly more than that of the control group (P<0.001). No considerable difference was observed between the lecture and module groups (P>0.05). Given the results of the current study, advantages of student-centered educational methods, nursing workload, and the sensitive nature of the nursing profession, modules can be suggested as a suitable alternative method for lecture.

Relationship is among the first and highest human achievements which paves the way for human social life. An important mission of the humankind is to develop and maintain interpersonal relationships. This study aimed to examine the effectiveness of training relationship enhancement on stress, anxiety, depression, and self–esteem of working women. In this quasi-experimental study with pre-test and post-test, 30 working women from Qayen, South Khorasan, were the participants. The participants were initially asked to fill out DASS questionnaire (21 items) and Cooper-Smith’s Self-esteem Inventory. After taking the pretest, they attended eight training sessions on relationship enhancement skills. At the end of the last session, the participants were asked again to fill out DASS questionnaire and Cooper-Smith’s Self-esteem Inventory. The data were analyzed in SPSS (version 13) using Wilcoxon and paired t-test at 0.05. Results indicate that self-esteem mean score increased significantly after the intervention (P<0.001), while that of stress, anxiety, and depression decreased significantly (P<0.001). Teaching relationship enhancement skills helps to reduce stress, anxiety, and depression but increases self-esteem among working women. As a result, these trainings need to be taken into account by psychologists and family counselors so as to reduce and prevent psychological disorders and harms to individuals and families.

Fatigue is the most common side effect in hemodialysis patients. A relavent theory to fatigue in hemodialysis patients, the unpleasant theory states that fatigue has physical, psychological, and situational factors. Building on unpleasant theory, this study sought to examine some factors relavent to fatigue in hemodialysis patients. Matrials and This analytical-descriptive study included all patients (n=182) who were eligible according to inclusion criteria. Data were collected through questionnaires including demographic information, Fatigue Severity Scale, ESSI, and Beck Depression whose reliabilty and validity were confirmed. Data was analyzed in SPSS (version 16) using independent t-test, ANOVA and Tukey Fatigue score mean of the patients was 3.94±1.22. From among them, 151 (83%) had good social support. There was no significant difference between fatigue scores of participants in terms of gender, age, malnutrition, and anemia. However, there was a significant difference in terms of depression (P<0.001), duration of dialysis (P<0.003), and social support (P<0.01). Given the high prevalence of fatigue in hemodialysis patients and its effects on their physical and mental performance, care providers are recommended to gain more knowledge about how to reduce its impact on dialysis patients.

The mortality rate for patients with end-stage renal disease does not happen by hemodialysis. However, they would experience several complications that can impact their quality of life. Renal transplantation improves the physical aspect of life quality. The purpose of this study is to compare the quality of life in patients undergoing hemodialysis and kidney transplantation in Birjand. In this cross-sectional study, 60 hemodialysis patients referring to Valieasr Hospital and 58 patients with kidney transplantations in Birjand who had inclusion criteria were selected. The data collection instrument was SF-36questionnaire whose reliability was calculated as 0.65 by Cronbach’s alpha. Data were analyzed SPSS (v ersion 16) using independent t-test, ANOVA, Range Tukey and Pearson. The mean scores for quality of life in hemodialysis and transplant patients were 40.03±18.63 and 69.08±11.03 respectively. The overall mean score for quality of life and its areas was significantly more in transplant than hemodialysis patients (P=0.0001). Given the lower quality of life in hemodialysis patients, it is desirable to facilitate the process of transplantation as soon as possible and to make plans to improve patients’ quality of life until they have transplantations.

Previous studies have shown that carvacrol has hypotensive, bradycardic and calcium inhibitory effects. Since the opening of calcium channels have an important role in the incidence of arrhythmias, this study aimed to investigate whether carvacrol has anti-arrhythmic effects against aconitine-induced arrhythmia or not. In this experimental study, seventy male Wistar rats were divided into seven groups of ten: Group 1 as the control Group; Group 2 as the pretreatment with lidocaine (10 mg/kg); Group 3 and 4 as the pretreatment with carvacrol 10 and 50 µg/kg; Group 5 as the treatment with lidocaine (10 mg/kg); and Group 6 and 7 as the treatment with carvacrol 50 µg/kg. Lidocaine and carvacrol were infused intravenously as pretreatment and treatment respectively before and after the infusion of aconitine (as an arrhythmic substance). Ventricular arrhythmia including the onset of arrhythmia, incidence percentage of ventricular tachycardia and fibrillation, and irreversible ventricular fibrillation and atrial fibrillation were monitored following the infusion of aconitine for 30 minutes. Data were analyzed in GraphPad Prism statistical software by one-way ANOVA, Tukey’s post hoc test, and Fisher’s exact test. Data showed that the magnitude of ventricular arrhythmia including the onset of arrhythmia, incidence percentage of ventricular tachycardia and fibrillation, and irreversible ventricular fibrillation significantly reduced in pretreatment and treatment groups with lidocaine. It also reduced markedly in pretreatment and treatment groups with carvacrol 50 µg/kg, although not as much as in the lidocaine group. There was not any significant difference between carvacrol 10 µg/kg groups and control group both in pretreatment and treatment protocol. The findings of this study indicate that the maximum dose of carvacrol which did not have any significant effect on blood pressure reduced the magnitude of aconitine-induced arrhythmia. This may use prevention and alternative of cardiac arrhythmias

Carbamazepine (CBZ) is an anticonvulsant drug that is widely used, primarily to treat seizures. One of the side effects of this medication during pregnancy is the reduced fetal growth. The jujube has been widely used in traditional medicine because of its special compound. The purpose of this study was to evaluate the preventive effects of aqueous extract of jujube on growth index of mice fetuses exposed to Carbamazepine. In this study, 100 Balb/C mice (28-30 gr; 8-9 weeks-old) were divided into eight experimental and two control groups. Experimental groups (І, ІІІ, V) and (ІІ, IV, VI) received daily intraperitoneal injections of 50 and 100 mg/kg of CBZ, respectively. Experimental groups (ІІІ, IV) and groups (V, VI) were gavaged doses of 200 and 400 mg/kg of aqueous extract of jujube respectively. Groups VII and VIII received only doses of 200 and 400 mg/kg of aqueous extract of jujube respectively. Control groups І and ІІ were gavaged to normal saline and tween respectively. Injections were done on 0 to 15 gestational days (GD), and aqueous extract was gavaged along with CBZ starting 10 days prior to gestation. On GD 18, fetuses were removed for weighing and crown-rump measuring. Data were analyzed by ANOVA and Tukey tests using SPSS (version 18) at 0.05%. Average weight and body length of fetuses in experimental groups I and II, that received CBZ, significantly reduced compared with control groups. In the fetuses of experimental groups V (1.20±0.38) and VI (1.21±0.21 gr) that recieved jujube extract (400 mg/day) with CBZ, the mean weight of these fetuses increased meaningfully in comparison with the experimental groups I (0.93±0.19 gr) and II (0.92±0.26 gr) respectively. This study showed that aqueous extracts of jujube can have preventive effects on reducing effect of CBZ on birth fetal weight.

Nurses are moral agents whose identity and integrity can be affected by moral distress. Oncology nurses face challenging clinical situations that led to moral distress. This study evaluated the clinical situations leading to moral distress experienced by oncology nurses. This descriptive-analytical study included 148 nurses with inclusion criteria who worked in oncology wards of hospitals in Tehran. The instruments included the demographic questionnaire and Corley’s Moral Distress Scale revised by Hamric wherein morally distressful situations are categorized in three sections. Data were analyzed in SPSS using descriptive statistics and within groups variance at the level of P<0.05. The moral distress mean intensity and mean frequency were 2.13±0.44 and 2.08±0.36 respectively. Nurses experienced high moral distress in cases where they failed to attain i nformed consent from the patients or when they ignored the physician’s order to take test from end-life patients which they felt were unnecessary. The greatest moral distress frequency and intensity score mean was associated with futile care. M oral distress is high Oncology nurses that show organizational intervention for the nurse education and supports.