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Showing 14 results for Critical Care

Zahra Sadeghi, Mitra Payami, Seyed Nooredin Moosavinasab,
Volume 2, Issue 2 (2-2013)

Background and Objectives: Hospitalization of patients in ICU can be stressful for both patients and their families. This study aimed to assess the effect of family participation in ICU patients care on family’s anxiety level. Material and Methods: This is a quasi-experimental before-after study. Family members of patients hospitalized in ICU of Ayatollah Mousavi Hospital, Zanjan were randomly divided into two experimental and control groups. Family members of the experimental group patients collaborated with the nurses in their patients care two hours a day from the 3rd day to the 7th day of the hospitalization. The control group patients were treated according to the ICU routine. Participants in both groups filled out the DASS-21 questionnaire before and after the intervention. Data were analyzed using the t-test in the SPSS-16. Results: There was a significant difference in the anxiety score among the participants in the intervention group before (21.6±8.4) and after the intervention (12.6±7) (p<0.001). Conclusion: The result of the study indicated that the participation of the family members of patients hospitalized in the ICU in patients care can be effective in decreasing their stress and anxiety.

Mehdi Bassiri Moghadam, Shirin Madadkar Dehkordi, Ali Mohammadpour, Amir Abas Vaezi, ,
Volume 3, Issue 2 (2-2014)

Background and Objectives: Fatigue is a common complaint among patients who undergo hemodialysis. Fatigue influences their somatic, mental, sentimental and cognitive states. This study aimed to determine the effect of progressive muscle relaxation technique on fatigue among patients treated with hemodialysis. Materials and Methods: In this clinical trial, 90 patients undergoing hemodialysis were recruited from two hemodialysis centers in Gonabad and Yazd and were randomly allocated into control (n=45) and trial (n=45) groups. The progressive muscle relaxation technique was presented to the trial group during three sessions. The patients were asked to make calm once a day for six weeks and at the end complete the relaxtion form. No trainings were provided for the control group patients. The intensity of fatigue was compared between the two groups. Data were collected using a questionnaire including demographic specifications, tools for assessing the severity of fatigue and self-reported checklists. Data was analyzed using the statistical methods in the SPSS. Results: The results showed no significant differences in the level of fatigue between the two groups before the intervention (p=0.12). There was significant difference in level of fatigue between the two groups after the intervention (p<0.001). Conclusion: Using the progressive muscle relaxation technique is recommended for patients of the hemodialysis wards.

Sona Pashaee, Sima Lakdizaji, Azad Rahmani, Vahid Zamanzadeh,
Volume 4, Issue 1 (9-2014)

Background and Objectives: Caring is central to the nature of nursing. Due to the special conditions of patients in the critical care wards, caring behaviors are important to be considered. Despite the important role of nurses in quality of care, viewpoints of nurses on the caring behaviors are unclear. This study investigated the views of critical care nurses toward caring behaviors priorities. Materials and Methods: In this descriptive-correlative study, 200 critical care nurses were selected based on the stratified random sampling. Data were collected using the Caring Questionnaire developed by Larson. Caring behaviors were ranked on a 5-point Likert-type scale with 57 caring behavior items ordered in six subscales. The data were analyzed using the statistical methods in the SPSS-21.0. Results: Results showed that the highest priority was related to the "confident communication with patients" and the lowest priority was related to the "being accessible" and "anticipation". Furthermore, nurses ages had significant relationship with physical relaxation, confident relationship and follow-ups through subgroups (p=0.01). Female nurses ranked "monitors and follow-ups through" higher than male nurses (p=0.01). Conclusion: Most nurses based their work according to the confident communication with patients. The availability and anticipated needs of the patients care were identified as the lowest priorities. Providing long-term and short-term programs by policymakers in order to conduct appropriate trainings are recommended.

Leili Yekefalah, Tahere Ashktorab, Homan Manouchehri, ,
Volume 4, Issue 2 (3-2015)

Background and Objectives: The concept and meaning of futile care depends on the existing culture, values, religion, beliefs, medical achievements and emotional status of a country. We aimed to elaborate the concept of futile care from view points of nurses working in critical care units in Iran. Materials and Methods: The participants of this phenomenological study included 25 nurses working in the ICUs. Face-to-face interviews and observations were used to collect data. All interviews were recorded and codes and themes were extracted using the Van Manen's analysis method. Results: Initially, 191 codes were extracted. During data analysis and comparisons, the codes were reduced to 178 ones. Ultimately, nine sub-themes and four themes were emerged. The participants defined the futile care as: “useless and ineffective care that wastes resources and irritates and annoys the patients and nurse and includes Nursing and medical aspects”. Conclusion: Regarding key role of nurses in managing futile care, being aware of their experiences in this regard could be the initial step for providing useful care and delivering educational programs in ICUs.

Masoomeh Najafzadeh, Kourosh Amini, Soghrat Faghihzadeh, Hamidreza Monsef Esfahani,
Volume 5, Issue 2 (2-2016)

Background and Objectives: Several studies have shown that nurses working in the ICUs experience high levels of anxiety. Anxiety can not only negatively affect them, but may decrease the quality of care provided by them. The present study aimed to assess the effect of Valerian on anxiety among nurses working in the ICUs of Zanjan teaching hospitals.

Materials and Methods: In this clinical trial, nurses working in morning and evening shifts were recruited to the study. A dose of 530 mg Herbal Sedamin capsules containing dried roots of Valeriana Officinallis were consumed by the nurses in the intervention group twice a day for one week. The control group received placebo. The Speilberger's State-Trait anxiety inventory was completed by the nurses at baseline and after the intervention. The independent t-test and paired t-test were used to analyse data.

Results: After the intervention in two groups (Valerian and Placebo), the trait and state anxiety scores were significantly lower than before of the intervention. But there were no significant differences in the trait and state anxiety scores of the questionnaire between the experimental group and control groups after the intervention (P=0.846).

Conclusion: It seems that the special and different nature of the ICUs has hampered the effectiveness of this herbal medicine. Further studies with higher doses, or in other settings is suggested.

Sousan Valizadeh, Hamidreza Haririan,
Volume 5, Issue 2 (2-2016)

Background and Objectives: Motivation is an internal state that fosters human activities; and is associated with factors such as job satisfaction, quality of care and durability of nurses in their profession. The aim of this study was to review and describe work motivation among nurses around the world.

Materials and Methods: After searching the related keywords and removing the duplicates, we extracted data from three English and ten Persian articles. Quality of the articles was assessed using the STROBE Statement.

Results: Most of the articles had reported that nurses work motivation was low. The most important factors affecting nurses work motivation included altruism, appropriate and respectful interpersonal interactions, adequate wages, proper working hours and free time to do own things, high autonomy, authorities support and recognition of work experience, social reputation, and non discrimination in working conditions and payments.

Conclusion: It is suggested that the policymakers in nursing consider factors affecting the work motivation.

Fatemeh Mahdavisaeb, Mahin Ruhani, Nasrin Hanifi, Kurosh Kamali,
Volume 6, Issue 1 (6-2016)

Background and Objectives: The high clinical competency of Critical Care Nurses (CCNs) is required, as the quality of nursing care in critical care units (CCUs) with critically ill patients is extremely important. This study was conducted to compare CCNs' clinical competency using self-assessment method and assessment by their Head nurses.

Materials and Methods: This cross-sectional study was conducted on 148 CCNs who were included in the study in a period of six months (June -November 2014), in the hospitals of the Zanjan university of medical sciences. Data was collected using Nurse Competency Scale (NCS) which assesses 63 skills in seven different domains. The Cohen's kappa coefficient was used to compare the agreement between the clinical competency and the use of skills in CCNs and their head nurses.

Results: The inter-rater agreement was poor between the nurses and their Head nurses in the evaluation of the clinical competency, and in two aspects was very poor. The "Quality assurance" (0.098) and the" Helping Role" (0.373) domains had the lowest and the highest level of agreement, respectively. The inter-rater agreement of the use of skills by nurses was reported very poor in all domains.

Conclusion: The current study revealed that there is no agreement between the evaluation of CCNs' clinical competency by own nurses and their head nurses indicating these two methods are not interchangeable.

Masoumeh Masoumi, Nasrin Hanifi, Mohammadreza Jamshidi, Soghrat Faghihzadeh,
Volume 6, Issue 1 (6-2016)

Background and Objectives: Oral care is a fundamental activity in nursing care. Providing oral care for ill patients, who are not able to keep their oral care, would provide comfort for patients and prevented them from oral lesions. This study was conducted to compare of the effect of Ozone water with Chlorhexidine in prevention of oral lesions in patients in critical care units.

Materials and Methods: This randomized controlled trial was carried out on 74 patients under mechanical ventilation in intensive care unit of Mousavi hospital in Zanjan. The participants were selected preliminary using convenience sampling, and then allocated randomly to two groups of intervention (n=39) and control (n=35) groups. Data was collected using the Beck Oral Assessment Scale (BOAS) scale. The data were analyzed using univariate statistical analysis (independent t statistical tests, Fisher's exact test, and Cochran Q (in SPSS16.

Results: The results of the study showed that the mean score of oral lesions according to BOAS in intervention group was almost the same as control groups by the third day of intervention. However, the mean score of oral lesions in the intervention group was reduced statistically compared to control group (P=0/013) on the fourth day.

Conclusion: The results of the current study revealed that Ozone water is more effective than chlorhexodone in prevention of oral lesions.

Khadijeh Yazdi, Fariba Baghani, Shakiba Mozari, Ali Akbar Abdollahi, Arazberdi Ghorchai,
Volume 6, Issue 4 (3-2017)

Background: Pain control during and after surgeries can reduce subsequent complications, improve the recovery period of the patient after the surgery and immediately after discharge from the hospital, and shorten the length of stay in the hospital.

Objectives: The present research aimed to study the relationship between the depth of anesthesia and severity of pain after general anesthesia.

Methods: This prospective study carried out on 57 patients undergoing hernia surgery during the summer of 2014. The subjects were selected based on convenience sampling method. The same technique of anesthesia was used for all patients. The depth of anesthesia was monitored using bispectral index (BIS) and recorded at five-minute intervals. In addition, the severity of pain in the recovery and during the first 6 hours after the surgery was measured by a numerical scale. The obtained data were statistically analyzed using ANOVA and correlation coefficient in SPSS-18 at a significant level of P<0.05.

Results: According to the results, the mean age of subjects was 45.54±13.46. In terms of gender, 36 subjects were male and 21 of them were female. The normal depth of anesthesia (40-60) was experienced by 59.6% of patients. The results also showed that there is a significant correlation between depth of anesthesia and severity of pain in the recovery (P=0.001, r=0.694) and during the first 6 hours after the surgery (P=0.001, r=0.734).

Conclusion: The present study showed that monitoring depth of anesthesia during surgery, in addition to helping nurses to monitor patients more accurately, can prevent some of the complications of anesthesia such as severe pain.

Maryam Zaeimi, Farhad Ramazani-Badr, Mohsen Bahrami,
Volume 6, Issue 4 (3-2017)

Background: Underlying diseases and aggressive procedures, such as different types of surgery and care, for patients with critical conditions in intensive care units (ICU) may be associated with physiological disorders.

Objectives: This study intended to determine the effect of therapeutic touch on physiological variables of patients undergoing mechanical ventilation in ICU.

Methods: This randomized clinical trial with a control group was conducted on 60 mechanically ventilated patients hospitalized in internal and adult intensive care units of educational hospitals of Zanjan University of Medical Sciences from 22 November 2014 to 22 June 2015. Patients were randomly divided into the intervention and placebo groups. Therapeutic touch was administered in four sessions. Physiological variables, such as Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial

Pressure (MAP), and Heart Rate (HR) were recorded in both groups before and after each therapeutic touch session. Data was analyzed using SPSS 21.

Results: The results from comparison of physiological variables in the intervention group before each session showed a significant reduction only in heart rate (p<0.001). Moreover, results from comparison of physiological variables in the intervention group after therapeutic sessions showed significant differences in SBP (p=0.025), MBP (p=0.033), and HR (p=0.002).

Conclusion: It seems that therapeutic touch can result in a greater stability of some physiological variables of mechanically ventilated patients, if it is administered frequently for long term.

Zahra Zolfaghari Lake , Mahin Roohani, Elham Shakibazadeh, Koorosh Kamali,
Volume 6, Issue 4 (3-2017)


Background: Illness perception can affect health-related behaviors and disease outcomes.

Objectives: To determine the effect of an educational intervention of improving illness perception on some modifiable risk factors of coronary artery disease.

Methods: In this clinical trial, 100 patients undergoing coronary angiography that met the inclusion criteria were divided randomly into two intervention and control groups. In the intervention group, three educational sessions were conducted individually, while usual care was conducted for the control group. Measurements on fasting blood glucose, cholesterol, triglyceride, blood pressure, body mass index, and smoking status were gathered at baseline, immediately and six months after the intervention in both groups. Data were analyzed using the SPSS.

Results: The mean of systolic blood pressure (p<0.005), fasting triglycerides (p<0.005), and fasting blood glucose (p<0.005) were significantly different before and after the intervention between the two groups.

Conclusion: Improvement illness perception through educational intervention can affect risk factors of coronary artery disease.

Arezoo Monfared, Mostafa Soodmand, Golshan Ghasemzadeh,
Volume 7, Issue 1 (6-2017)

Background: Delirium is a common problem in patients hospitalized in Intensive Care Unit. Despite the importance, only less than 13% of cases are diagnosed by physicians and medical personnel.

Objectives: The present research aimed to study knowledge and attitude of critical care nurses towards delirium.

Methods: This cross-sectional study was conducted in Iran. Convenience sampling was used to enroll nurses (186 persons) working in intensive care units of Rasht educational hospitals affiliated to Guilan University of Medical Sciences in 2015. Data collection instruments included a three part questionnaire: demographic data, 15- item questionnaire formerly used by Guthrie and Sendelbach (2009) on nurses’ knowledge about delirium, and 10-item questionnaire adopted from Herrero et al on attitude of the nurses towards delirium. The obtained data were statistically analyzed using descriptive statistics, Pearson's correlation coefficient and t- test in SPSS-20.

Results: The majority of nurses (68.3%) have intermediate knowledge about delirium and only 24.6 percent reported good knowledge and 76 percent had positive attitude about delirium.

Conclusion: Nursing knowledge and awareness have a significant role in improvement of the quality of healthcare and preventive measures, as well as the attitude of nurses towards dealing with delirium patients. Hence, it is recommended to give greater importance to academic courses and ongoing post-graduation professional development programs in the workplace, as a globally practiced healthcare quality improvement strategy.

Khalil Yosefi, Mohammadreza Dinmohammadi, Mahdi Moosaeifard, Soghrat Faghihzadeh,
Volume 7, Issue 2 (10-2017)

Background: Dialysis adequacy is one of the most important factors in determining the survival rate and mortality of dialysis patients.
Objectives: The aim of this study was to determine the dialysis adequacy of patients undergoing chronic hemodialysis at dialysis centers located in the province of Zanjan, located in northwest Iran.
Methods: This descriptive cross-sectional study was performed on 257 patients undergoing chronic hemodialysis with an available sampling method in 6 dialysis centers in the province of Zanjan. The hemodialysis sessions were performed for 3 to 4 hours using via synthetic filters and bicarbonate dialysate. To determine the adequacy of dialysis, serum BUN levels were assessed before and after dialysis. The standard software provided by the Ministry of Health was used to calculate the adequacy of dialysis and Kt/V was considered to be at least 1.2.
Results: The most common underlying causes of chronic dialysis were hypertension (41.2%) and diabetes mellitus (35.8%), respectively. Mean Kt/V and URR were 1.26±0.34 and 63.55±9.5%, respectively. The difference among these indexes was significant between men and women (p<0.05). Also, dialysis adequacy was significantly associated with increased dialysis frequency, blood flow rate, interdialytic weight gain, vascular access and dialysis shift (p<0.05).
Conclusion: Despite the relatively favorable dialysis adequacy among patients, this index is highly variable based on patient gender, the dialysis center, location, frequency of dialysis, blood flow rate, interdialytic weight gain, type of vascular access and dialysis shift. Therefore, serious attention and greater caution are recommended among the dialysis centers of the province

Nastaran Mansoreyeh, Hamid Poursharifi, Mohammadreza Taban Sadeghi, Mohammadreza Seirafi,
Volume 7, Issue 3 (11-2017)

Background: As a chronic disease, heart failure (HF) is a growing problem that not only impacts patients but also their family members and friends. Self-care is the main part of HF treatment. Despite the significance of determining variables involved in self-care, the relationships of self-efficacy, illness perception, and social support with self-care and the predictive roles of these variables in the treatment of HF have not been investigated.
Objectives: The present study was aimed at exploring the predictive roles of self-efficacy, illness perception, and social support in self-care of patients with heart failure.
Methods: In this predictive correlation study, 149 patients with HF were selected through convenience sampling from Tabriz Research Treatment Centre of Heart in 2016. To collect data, a demographic information questionnaire, self-care behaviour scale, general self-efficacy (GSE), brief illness perception questionnaire (Brief-IPQ), and social support scale were used. To analyse data, SPSS software version 16, descriptive statistics, Pearson correlation coefficient, and multiple stepwise regression analyses were employed.
Results: Out of 149 subjects, 102 (68%) participants were male, and 47 (32%) of them were female. The mean and standard deviation of samples’ age were (64.40±10.32) ranging from 37 to 88 years. Most of participants were married (82%). The mean scores were as follows: Self-care (40.66±13.16), self-efficacy (45.81±22.03), illness perception (56.05±18.24), and social support (49.09±6.74). Data analysis demonstrated significant correlations between illness perception and self-care (p<0.001, r=0.649), self-efficacy and self-care (p<0.001, r=-0.678), social support and self-care (p<0.001, r=-0.518), and age and self-care (p<0.001, r=-0.506). The standardized coefficient of illness perception was (β=0.274), social support was (β=-0.237), self-efficacy was (β=-0.230), and age was (β=-0.211). In addition, 56% of self-care variance is explained by age, social support, self-efficacy, and illness perception.
Conclusion: All of the investigated variables were found to have a predictive role in self-care. Illness perception was recognized as the most effective factor in predicting self-care. Hence, illness perception can be used to explain 27% of self-care ability of patients with HF.

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