Journal of Caring Sciences
Volume:7 Issue: 4, Dec 2018

Epilepsy is a treatable and curable brain disorder. However major proportion of individuals with this disease in developing countries receives no treatment because of misunderstandings of the public. Other than that, poor adherence to ordered medication is considered the primary cause of drug therapy failure in epilepsy. This study conducted to assess the adherence pattern to antiepileptic regimen, among patients with epilepsy and to identify the clinical and patient-related factors contributing as barriers. A cross sectional survey design was used in 100 epilepsy patients in an Outpatient unit of tertiary care center. A Convenient sampling technique was used to enroll the patients who meet inclusion criteria. Structured interview with pre-tested questionnaire and eight item Morisky Medication Adherence Scale was used to collect the data. Descriptive and inferential statistics were used for analysis of data. Descriptive statistics (mean, standard deviation, frequency and percentages) were used to describe the clinical and demographic variables of study participants. The determinants of medication adherence were analyzed using Chi-Square test and independent student t- test. The analysis was done with SPSS 20th version. Majority (71%) of patients were not adherent to antiepileptic treatment. Severity of seizure (indicated by the presence of seizure last year), medication frequency and complexity of treatment were found to have significant association with the Anti-Epileptic Drugs (AED) adherence status. Status of adherence is significantly associated with frequency of seizure/year and positive life style. As Medication adherence was observed to be low, services for adherence counseling and health educational interventions in the epilepsy clinics is recommended.

Attending to caregiving experiences of family caregivers of stroke survivors is important in person-centered stroke rehabilitation. This study explored caregiving appraisals by family caregivers of stroke survivors in Nigeria. A cross-sectional survey of family caregivers’ negative and positive appraisals of caregiving was conducted using the 24-item 4-domain revised Caregiving Appraisal Scale (rCAS). Mann Whitney U and Kruskal-Wallis tests were used to identify differences in caregiving appraisals based on specific caregiver and stroke survivor variables. Seventy-three caregiver and care recipient dyads participated in the study. Mean age of the caregivers was 31.51 (9.82) years. From a score of 5, and higher scores depicting higher appraisal, mean (SD) score for caregiving satisfaction and caregiving mastery (positive appraisal domains) was 4.23 (0.97) and 4.04 (0.92) respectively while 2.29 (0.98) and 2.11 (0.93) were respectively recorded for caregiving burden and environmental impact (negative appraisal). Caregivers’ gender, age, and employment status resulted in significantly different appraisals with female caregivers having higher caregiving mastery (U = 446, P<0.05), caregiving satisfaction (U = 384.5, P<0.01), and also caregiving burden (U = 382.5, P<0.01) compared to their male counterparts; while older (U = 330; P<0.05) and employed (U = 437.5, P<0.05) family caregivers reported higher caregiving satisfaction and burden respectively than younger and unemployed family caregivers. Given the comparatively higher positive caregiving appraisal, and the documented benefits of positive caregiving appraisal, efforts should be geared towards identifying effective means of reinforcing positive appraisal, and reducing negative stroke caregiving appraisal, especially for female, older and employed family caregivers.

Heart failure is a chronic medical condition that, despite the existing therapies, involves different aspects of an individual’s life (such as self-care capability). Illness perception is one of the most important variables which seem to improve the self-efficacy skills in chronic diseases such as heart failure. Therefore, this study aimed to investigate the effect of family–centered empowerment model on the perception of the illness in heart failure patients. This interventional study was performed on 70 heart failure patients, assigned into control and experimental groups, admitted to the heart clinic of Hazrate Fatemeh hospital in Shiraz. After the convenience sampling, the patients were divided into two control and intervention groups by block randomization method. For experimental group, the family-centered empowerment modeling was done in 5 sessions. The research materials included demographic information and Brief illness perception questionnaires (B-IPQ). Data were analyzed using SPSS v.13 software. The statistical tests included Wilcoxon, Man-Whitney, and Independent t-test. P value less than 0.05 was considered as significant. In this study, both control and experimental groups were homogeneous with demographic information. Before the intervention in different dimensions of illness perception, all of the values in both groups were the same; However, after the intervention, a significant difference was observed in all of the dimensions of illness perception, except for Time line; so that the most and the least changes were related to the concern (1.09 (0.61) vs 3 (0.93)), and identity dimensions (0.97 (0.61) vs 2.11 (0.67)), respectively. On the basis of the above, it can be concluded that this model modifies the illness perceptions in heart failure patients. Cardiac nurses should consider family- based empowerment model as a treatment for heart failure patients

A consistent approach to pain assessment for patients admitted to intensive care unit (ICU) is a major difficulty for health practitioners due to some patients’ inability, to express their pain verbally. This study aimed to assess pain behaviors (PBs) in traumatic brain injury (TBI) patients at different levels of consciousness. This study used a repeated-measure, within-subject design with 35 patients admitted to an ICU. The data were collected through observations of nociceptive and non-nociceptive procedures, which were recorded through a 47-item behavior-rating checklist. The analyses were performed by SPSS ver.13 software. The most frequently observed PBs during nociceptive procedures were facial expression levator contractions (65.7%), sudden eye openings (34.3%), frowning (31.4%), lip changes (31.4%), clear movement of extremities (57.1%), neck stiffness (42.9%), sighing (31.4%), and moaning (31.4%). The number of PBs exhibited by participants during nociceptive procedures was significantly higher than those observed before and 15 minutes after the procedures. Also, the number of exhibited PBs in patients during nociceptive procedures was significantly greater than that of exhibited PBs during the non-nociceptive procedure. The results showed a significant difference between different levels of consciousness and also between the numbers of exhibited PBs in participants with different levels of traumatic brain injury severity. The present study showed that most of the behaviors that have been observed during painful stimulation in patients with traumatic brain injury included facial expressions, sudden eye opening, frowning, lip changes, clear movements of extremities, neck stiffness, and sighing or moaning.

The present study was conducted to evaluate the effects of Hypericum Perforatum ointment on perineal pain intensity following episiotomy among primiparous women. This triple-blind clinical trial was performed on 98 eligible primiparous women referring to selected educational hospital of Tehran University of Medical Sciences for normal vaginal delivery. Block Randomization (in 1; 1 ratio) was used to categorize the participants continuously into two groups: intervention (using Hypericum Perforatum ointment) and control (using placebo ointment). Participants in each group used ointments (about 3 grams each time) on episiotomy site, twice a day and for a period of ten days. Our primary outcome was the pain intensity in different intervals following episiotomy. The data were analyzed by SPSS software (version 13) using student's t test, Mann-Whitney U test and chi-square test. We missed 14 participants during the study and analyzed the data from 42 participants in each group. The mean of pain scores revealed no significant differences before (mean difference=-0.33; P=0.46) and four hours (mean difference=0.57; P=0.13) after ointments use, between the intervention and control groups, while these differences were significant after eight hours (mean difference=2.17; P<0.001), five days (mean difference=2.20; P<0.001) and ten days (mean difference=2.21; P<0.001) following the intervention. Using Hypericum Perforatum ointment as a noninvasive, simple and effective topical formulation, can significantly reduce pain intensity of episiotomy site.

Percutaneous Coronary Intervention (PCI) has no effect on coronary artery atherosclerosis, thus the modification of physiological risk factors seems essential to prevent coronary artery disease (CAD). Then PCI patients have to receive multiple drug therapies in an attempt to prevent the recurrence of cardiac events. In spite of the evidence based on medication adherence to prevent post-PCI CAD development, medication adherence is the main concern for health care system. Accordingly, this study aims to determine the medication adherence and its related factors among these patients. In this cross-sectional study, the statistical community was the patients undergoing PCI at medical educational hospital of Dr. Heshmat in Rasht, Iran. 269 patients were selected by convenient sampling method. The data were collected by a questionnaire consisting of 4 parts, namely the socio-individual factors, Morisky medication adherence scale, hospital anxiety and depression scale and cardiac patient’s self-efficacy scale. Data analysis was done by descriptive statistics and the significance variables in univariate analysis were examined in a multi logistic regression model through considering co-linearity. The results showed that 75 patients (28%) didn’t adhere to the medication. In addition, the majority of them were reported to have clinical anxiety (44.2%) and mild depression (55.8%). Also, based on the results derived from multiple logistic regressions, only the spouse's educational level and family history of coronary artery disease were significant predictors of medication adherence. The current study findings display lack of complete post-PCI medication adherence, which underscores the importance of the existence of cardiac rehabilitation systems in the society. Therefore, it is recommended that cardiac rehabilitation centers be built in the society.

Thalassemia is a chronic hereditary anemia which can be associated with different psychological, emotional, and behavioral problems such as depression and anxiety. This study aimed to evaluate the effects of cognitive behavioral therapy on depression and anxiety of patients with thalassemia. This was a randomized controlled trial study. A total of 76 patients were randomly allocated to an experimental (n=38) and a control group (n=38). Patients in the experimental group were provided with cognitive behavioral therapy while their counterparts in the control group received routine care services. Depression and anxiety assessments were performed four weeks before the intervention as well as four and six weeks after that. Between-group and within-group comparisons were performed through the independent-sample t-tests and the paired sample t-test, respectively The post-test mean score of anxiety in the experimental group was significantly lower than that for the control group, while there was no significant difference between the groups regarding the post-test mean score of depression. The mean score of depression in both study groups decreased significantly. The rate of decrease in the experimental group was significantly greater than that in the control group. Cognitive behavioral therapy can be used to prevent or alleviate depression and anxiety among patients.

Improving self-management of the patients undergoing hemodialysis is an effective way to reduce complications and to improve the quality of life of them. The current study aims to assess the effects of group discussion on the promotion of self-management behaviors in hemodialysis patients. In this quasi -experimental clinical trial study (with experimental and control groups) 60 patients were arranged in two experimental and control groups through using convenience sampling with random allocation. Self-management interventions were conducted on the experimental group during 3 to 4 sessions of group discussion. The control group received routine interventions. The data were collected through Li and colleagues' self-management standard questionnaire before and 3 months after the intervention. The data were analyzed via SPSS software version 13 and chi-square, t-test, Mann-Whitney, and Wilcoxon test. The results showed that the mean scores of four dimension of self-management including participation with the medical team, problem solving, self-care and emotional management after the implementation of group were significantly different between the experimental and control groups. Based on the findings, group discussion was an effective educational method to promote self-management of chronic hemodialysis patients. Therefore, holding group discussion to reinforce the self- management behaviors in patients undergoing hemodialysis is recommended.