نشریه پرستاری مراقبت ویژه
سال نهم شماره 3 (پیاپی 31، Aug 2016)

Coronary artery diseases are among the most important causes of disability and coronary artery bypass graft (CABG) surgery is considered as one of the most important methods of treatment. The improvement of post-surgery adherence to treatment plan is one of the main healthcare objectives.
The present study attempted to determine the effect of family-centered empowerment model on the adherence of patients undergoing CABG to the treatment plans.
This research was a clinical trial and a quasi-experimental study, including pre and post tests with a control group performed on 102 patients and active family members of the patients hospitalized at the intensive care unit (ICU) of Imam Khomeini hospital of Tehran, Iran in 2014. For the experimental group, the family-centered empowerment model was implemented with four steps. The control group received only common care. The rate of patients’ adherence to the treatment plans was then investigated in three areas of diet, medication, and physical activities before and after the intervention, and the data were analyzed using PASW Statistics V18 software.
The two groups were similar in terms of demographic variables. After the intervention, there was a significant difference based on the results of the independent T-test in terms of mean scores of adherence to the treatment plan in the three areas mentioned above (P = 0.000). Also, before and after the intervention, a significant difference was observed in the experimental group in terms of the above mean scores (P = 0.000).
Based on the research findings, the family-centered empowerment model seems to be practical and feasible for the patients under CABG, which can bring improvement or correction of adherence to the treatment plan.

It seems that using Pilates exercises can increase quality of life of patients on hemodialysis.
This study aimed to determine the effect of Pilates exercises on the quality of life of patients on hemodialysis.
For this randomized controlled clinical trial, we enrolled 60 hemodialysis patients referred to Shahid Beheshti and Akhavan hospitals in Kashan city during 2014 and 2015. The subjects were randomly allocated to an experimental group (n = 30) and a control group (n = 30). Demographic information and quality of life short form (KDQOL SF) questionnaires were completed by the two groups at the beginning of the study. Then, modified Pilates exercises were carried out by the experimental group three times a week over a period of eight weeks. The KDQOL SF questionnaire was completed by all participants, at the beginning and two months after completion of the intervention. Data analysis was conducted using χ2 test, independent t-test, and paired t-test on SPSS software version 16.
Mean scores of QOL dimensions before and after the intervention are presented in Table 2. There was a significant difference in QOL Dimensions of the experimental group before and after the intervention (P ≤ 0.05). Mean differences of QOL dimensions at the Beginning and two months after the Study in the two Groups showed that there are significant differences in QOL Dimensions in the two groups (P ≤ 0.05).
The findings affirmed the positive effects of the Pilates exercise on the quality of life of patients on hemodialysis.

The demand for medical emergencies often begins with a call to a dispatch center. Appropriate performance of this unit significantly influences providing effective services.
The current study aimed to compare the effect of using telephone triage manual revised by New Jersey and the conventional methods on accuracy of triage done by 115 emergency medical dispatchers of Qom, Iran, in 2012.
This quasi-experimental study aimed to compare the effects of two conventional and New Jersey revised methods on performance of emergency medical dispatchers of Qom. Conventional (September and October) and New Jersey data (December and January) were extracted and compared. November was skipped due to emergency medical dispatcher familiarity with the program.
Performing the new method non-significantly changed the response time (P = 0.053) and communication skill (P = 0.053). Scientific and medical skills (P = 0.000) were significantly changed. Overall performance significantly improved (P = 0.000).
The revised New Jersey method significantly increased appropriate overall performance of the communication experts and decreased their dysfunction.

Researches have shown that in some countries where patients are transferred from intensive care to the general ward, they experience mental challenges, including anxiety. However, in Iran no researches have been done on this subject.
The aim of this study was to evaluate the prevalence of anxiety in patients transferred from the intensive care unit to the general ward.
This study was a cross-sectional study. Samples of this study included 110 patients transferred from the intensive care unit to the general ward. Spielberger’s questionnaire was used to collect data. To analyze the data, the SPSS version 16 software was used.
After entering variables in the multivariate logistic regression model, it was found, that there was only a significant relationship between gender and anxiety. Statistical data showed that 63.6% of patients had moderate anxiety.
According to the study, the subjects had high levels of anxiety, thus providing a platform for learning how to deal with anxiety seems to be required for these patients. The study also found that being female is directly related to the level of anxiety in these patients. Therefore, more attention to females during transfer from the intensive care to the general ward is important.

Coronary angiography (CAG) is one of the procedures for diagnosis of coronary artery disease (CAD). It may have severe complications. Providing patient education based on standards can lead to reduction in complication risks and increase patient satisfaction.
Consequently, the present study was conducted to audit discharge education for CAG patients.
In this descriptive study, 387 discharge educations of CAG patients were observed by event sampling. The data were collected using demographic information of nurses and patients and a checklist formulated on the basis of standards for discharge education of CAG patients. This checklist had 35 items in six dimensions. The validity and reliability of the checklist was examined using content and validity and the Inter-rater correlation coefficient (ICC = 97%). The data was analyzed using SPSS20.
The results showed that the discharge education of CAG patients was weak in all dimensions. The highest education was found for the CAG wound care sub-domain. Education of bleeding control education, nurse-patient communication, changing life style education, emergency events education, and drugs usage dimensions were low.
The findings revealed that common CAG discharge education is not satisfactory in comparison with the standards. Factors that may contribute to this failure include not enough nursing staff, lack of education plan at the discharge time and ineffective supervision. Using this checklist is beneficial for better education outcomes. The findings recommend nurses to evaluate the economic, safety, and psychosocial situation of the patients as they may prevent the patient’s and their family’s ability to follow the discharge plans.

Many factors may be involved in fatigue of patients with chronic heart failure (CHF).
The present study was conducted to determine fatigue and associated factors in patients with heart failure.
The present descriptive-analytical study was conducted on patients with CHF admitted to Imam Sajjad hospital of Ramsar in 2014. Data collection tools included: 1) multidimensional assessment of fatigue (MAF) scale, 2) the Pittsburgh sleep quality index (PSQI), 3) the hospital anxiety and depression scale (HADS), and 4) demographic characteristics form and the hemoglobin and ejection fraction (EF) records. Data collection was done through interviews and observations.
The study was conducted on 100 CHF patients with a mean age of 68.8 ± 11.7 years. Overall, 69% of the patients reported fatigue, and 60.6% claimed severe fatigue. Fatigue was found to be significantly related to sleep disorders and anxiety, but not to depression and hemoglobin. Fatigue was predominantly affected by anxiety.
The results of the present study showed that a high percentage of patients with CHF experience fatigue .Fatigue is a subjective phenomenon that is often less attended to and needs to be clinically assessed; to promote health care in these patients, it is required to consider factors such as mood disorders (anxiety and depression) and sleep disorders.

A heart valve disease is an important cardiovascular disease. Patients need long-term care after heart valve replacement, while promoting such patients’ self-care is very important. In this study, the impacts of family-centered empowerment model on self-care of patients with prosthetic heart valves were assessed.
This clinical controlled study was done at Tehran armed forces hospitals in 2015. After transferring patients from the intensive care unit (ICU), samples of the study and active members of their family were selected through the convenient method. Family-centered empowerment model was performed for the experimental group in four steps: perceived threat, self-efficacy, self-esteem and evaluation through group discussion, group problem solving, educational participation (in three to five sessions) and providing educational cards and manual for the patients and the active members of their family. The control group received routine care. Patients’ self-care was assessed before and after the intervention and also one and half month after the intervention. There was no intervention for the control group. Data analysis was done through descriptive and inferential statistical tests via the SPSS 23 software.
Both groups were similar before the intervention in terms of demographic variables. The average self-care scores in the experimental and control groups in terms of knowledge was respectively 49.42 ± 5.77 and 50.58 ± 9.09, in the emotional aspect: 17.53 ± 3.43 and 17.26 ± 3.29 and in the functional aspect: 51.58 ± 6.03 and 53.84 ± 8.68; no significant difference was observed between the two groups, yet after the intervention, the average self-care scores in the experimental and control groups in terms of knowledge was, respectively, 60.11 ± 2.97 and 51.95 ± 7.38, in the emotional aspect, 22.32 ± 3.001 and 18.32 ± 5.513 and in the functional aspect, and 63.63 ± 5.11 and 53.11 ± 7.45 with a significant increase was observed for the self-care scores (P = 0.05). Self-care ability after one and half month was not only stable, yet had also increased.
Based on the findings of this study, performing family-centered empowerment model improves self-care in patients with prosthetic heart valve. It seems that performing this model has a positive impact on chronic diseases therefore it is recommended to use this model for these patients at a broader level.

Most patients hospitalized at intensive care units have a continuous infusion catheter in place for receiving drugs and solutions; nonetheless, blood sampling in these units is still performed through an invasive and painful venipuncture. However, it is possible to take blood from a peripheral venous catheter to obtain accurate laboratory test results and alleviate the suffering of patients.
The aim of this study was to compare hematology, chemistry, and blood gas values sampled from venipuncture and continuous infusion intravenous catheter.
In this cross-sectional comparative study, a convenient sample of 61 adult patients was drawn according to the inclusion and exclusion criteria, from the intensive care unit. Two blood samples, one from a continuous infusion catheter, which was already in place and one from venipuncture at the other extremity, were obtained from each patient. The two sets of samples were compared in terms of hematology, biochemistry and blood gas values by using the paired-samples t-test.
The two sets of samples differed significantly in terms of blood sugar values. Other differences between the two sets were not statistically significant.
Except for blood sugar, blood sampling from a continuous 24-hour infusion catheter produces reliable hematology, biochemistry and blood gas results as that of venipuncture blood sampling method. Moreover, compared with the routine venipuncture method, sampling from a continuous infusion catheter is simpler, easier and safer.