فریبا یعقوبی نیا

Anxiety in patients under Coronary Angiography leads to changes in cardiopulmonary parameters. The current study aimed to compare the effect of virtual reality and rhythmic breathing on the physiological parameters of patients undergoing coronary angiography.

In this clinical trial, 90 patients admitted to the cardiac care ward were studied in 2019-2020. They were selected by convenience sampling and randomly allocated into three groups: virtual reality, rhythmic breathing and control. Virtual reality and rhythmic breathing groups received intervention and the control group received routine care. Systolic and diastolic blood pressure, heart rate; respiration rate and arterial oxygen saturation were measured before, half an hour and one hour after the intervention in three groups.

Findings revealed that the pattern of changes of the mean of respiration and heart rate was significantly different in all the three stages of measures in the three groups (P˂0.001). In the case of systolic and diastolic blood pressure and arterial oxygen saturation, the pattern of changes did not show a significant difference in the three groups (P>0.05).

The use of these methods can lead to modification of some physiological parameters. This means nurses can use these methods as non-invasive, without side effects, cheap and applicable methods in order to improve patients’ physiological parameters.

Hospitalization in the Intensive Care Unit (ICU) is associated with side effects such as anxiety, pain and fear of an unknown environment and causes hemodynamic instabilities (increased blood pressure, pulse and breathing rates, etc.) These hemodynamic instabilities lead to the use of sensory stimulation programs which can be prevented, however knowing and using the best sensory stimulation program is of particular importance. The current study was carried out with aim of comparing the effect of auditory stimulation and tactile on the physiologic parameters in patients with Level of Consciousness hospitalized in the ICU in ‎Ali-Ebne-Abitaleb Hospital in Zahedan in 2021.

In this single-blind semi experimental study, at first 80 patients in the ICU in Ali-Ebne-Abitaleb Hospital who met the inclusion criteria were selected and then randomly allocated by permutation block into two groups of auditory stimulation and tactile. In the auditory stimulation group, a prepared auditory file was used for 15 minutes for three days. In the tactile group, touching the hands patients was done for 15 minutes for three days. Physiologic parameters such as heart rate, respiratory rate, systolic and diastolic pressure, mean arterial pressure and O2 saturation was measured and recorded 5 minutes before and after the intervention by Cardio Set LX110 monitoring.

Findings revealed that the mean of systolic pressure and O2 saturation was not significantly different after the intervention between the two groups (p > 0.05). However, in terms of the variables such as heart rate, respiratory rate, diastolic and mean artery pressure, the independent- T- test showed a significant difference after the intervention between the two groups (p < 0.05).

The application of the two stimulation methos can adjust some physiologic parameters in patients in ICUs. Furthermore, these methods can be used as simple, cost-effective and applicable methods for managing pain and recovering the physiologic parameters.

Anxiety in patients under Coronary angiography leads to changes in cardiopulmonary parameters. The current study aimed to compare the effect of virtual reality and rhythmic breathing on physiological parameters of patients undergoing coronary angiography.

In this clinical trial study, 90 patients admitted to the cardiac care ward were studied in 2019-2020. They were selected by convenience sampling and randomly allocated into three groups: virtual reality, rhythmic breathing and control. Virtual reality and rhythmic breathing groups received intervention and control group received routine care. Systolic and diastolic blood pressure, heart rate; respiration rate and arterial oxygen saturation were measured before, half and one hour after the intervention in three groups. Data were analyzed by SPSS-16 using repeated measures analysis of variance and Chi-square.   

The results showed that the pattern of changes of the mean of respiration and heart rate was significantly difference in three times of measures in the three groups (p = 0.001). In the case of systolic and diastolic blood pressure and arterial oxygen saturation, the pattern of changes did not show a significant difference in the three groups (p >0.05).

The use of these methods can lead to modification of some physiological parameters, so the nurses can use these methods as non-invasive, without side effects, cheap and applicable to improve patients’ physiological parameters.

Inadequate oral care in intubated patients leads to decreased salivation, dry mouth, dental plaque, gingivitis and accumulation of pathogenic bacteria in the mouth and throat and aspiration of the contents of the mouth into the trachea and subsequently causes ventilator associated pneumonia. Two mechanical and chemical methods have been recommended for oral care, and contradictory results have been reported regarding its effects on ventilator associated pneumonia. Therefore, the aim of this study was to compare the effect of comprehensive oral care program and combination of toothbrush and mouthwash with 0.2% chlorhexidine on the incidence of ventilator-associated pneumonia in intubated patients under mechanical ventilation.

Materials: 

The current study is a clinical trial that was performed in the intensive care unit of Khatam Al-Anbia Hospital in Zahedan in 2020. 90 ventilated patients who met the inclusion criteria were selected and then randomly allocated by permutation block into three groups of comprehensive oral care program, combined toothbrush program and chlorhexidine and control groups. Data collection tools were demographic information form, Modified Clinical Pulmonary Infection Score (MCPIS) and Beck Oral Assessment Scale (BOAS).

The incidence of ventilator-associated pneumonia was lower in the intervention groups than in the control group, But there was no significant difference in the incidence of pneumonia between the three groups. (P=0.168)

The incidence of ventilator-associated pneumonia in the use of a comprehensive oral care program, a combined program of toothbrush and chlorhexidine 0.2% and the control group were not different from each other and in fact these methods were not superior to each other in this regard. However, considering that clinically the incidence of pneumonia was lower in the intervention groups than in the control group, it indicates that a special care program or instruction should be used, while training health care workers based on specific instructions in the oral care is recommended.

 Coronary angiography is a stressful procedure for patients, and about 80% of the patients have expressed their anxiety before angiography. The current study aimed to compare the effects of virtual reality and rhythmic breathing on the anxiety of patients undergoing coronary angiography at the hospital of Ali-Ibne Abitaleb in Zahedan City, Iran, in 2019.

Methods & Materials:

 This clinical trial study was performed on 90 patients hospitalized in the Cardiac Care Unit of Ali-Ebne Abitaleb Hospital in Zahedan in 2019. The study subjects were selected by convenience sampling method and randomly assigned into three groups: virtual reality, rhythmic breathing, and control. Anxiety was measured before, half an hour, and one hour after the intervention by Spielberger questionnaire. The obtained data were analyzed in SPSS v. 16. Data analysis was performed by repeated measures ANOVA and the Chi-square tests at a significant level of 0.05.

 The Mean±SD scores of the anxiety of the research samples before the intervention in the virtual reality, rhythmic breathing, and control group were 57.56±7.82, 57.10±6.49, and 56.33±6.74, respectively. The Mean±SD scores of the anxiety of the research samples 1 hour after the intervention in the virtual reality, rhythmic breathing, and control group were 42.30±7.46, 47.46±6.14, and 55.93±6.47, respectively. The repeated measures ANOVA showed a significant difference between the anxiety in the three groups during the intervention (P˂0.001). This difference was between the control group with the virtual reality group (P˂0.001) and the rhythmic breathing group (P=0.004). Thus, reducing the research samples’ anxiety during the intervention was significantly more in the virtual reality and rhythmic breathing group than the control group.

 The results showed that virtual reality and rhythmic breathing lead to reduced anxiety in patients undergoing angiography. The application of these methods is suggested as they are non-invasive, inexpensive, without complications, and easy to implement.

In order to prevent the complications of the disease and improve the quality of life of patients with stroke, home-based care programs could be effective. This study aimed to assess such an intervention.

This quasi-experimental study was performed on 60 patients with stroke in Zahedan, Iran, in 2019. The intervention group received rehabilitation trainings for three sessions each lasting for 45 minutes. The control group received the usual care. The specific quality of life questionnaire for stroke patients was administered one and three months after the intervention. Data were analyzed using SPSS-22 software performing repeated measures analysis, independent t-test and chi-square.

The mean score of total quality of life in one and three months after the intervention was significantly higher in intervention group compared to the control group (p <0.001). The results of repeated measures analysis of variance regarding the effect of time and group on quality of life and its dimensions showed a statistically significant difference between the two groups (P <0.001).

Home-based rehabilitation intervention could improve quality of life of patients suffering from stroke.

Fever in children is one of the most common reasons that cause parents to go to the pediatric clinic for medical care. Differentiating between benign self-limiting viral disease and a serious bacterial infection is a major challenge for pediatricians. The present study was conducted to determine the etiology, clinical profile, and related factors of serious bacterial infection in children hospitalized with fever without a source.

This descriptive-analytical and cross-sectional study was performed on 241 children with fever greater than or equal to 38 ºC without other symptoms hospitalized in pediatric emergency ward of Ali-Ebne-abitaleb hospital in 2020. Demographic information and laboratory findings of patients as well as other information was obtained through history taking and recorded in information form. Then, children were examined for viral or bacterial fever in two groups.

Out of 241 examined children, 90 patients (37.3%) had severe bacterial infection (SBI) and 151 patients (62.7%) had viral infection. There was a significant difference between variables such as age, number of siblings, history of respiratory infections in parents and birth weight between the two bacterial and viral groups (p=0.001). The white blood cell count, neutrophil percentage, platelets and duration of fever were significantly different between the two groups (p=0.001).

Results showed that some laboratory and clinical factors are different between the two bacterial and viral groups and can help us differentiate them.

Patients with acute coronary syndrome suffer from relapse and progression of disability due to poor adherence to treatment plans. The current study aimed to determine the effect of teach-back on treatment adherence in patients with acute coronary syndrome.

A semi-experimental study was carried out in 70 patients with acute coronary syndrome in cardiac care units in educational hospitals of Zahedan, Iran, 2019. The patients were selected by convenience sampling and randomly assigned into intervention group or control group. Demographic information questionnaire and treatment adherence questionnaire developed by Ziaee were used. The intervention group received individual trainings based on teach-back method during three sessions of 30-45 min, every other day, 24 hr after admission to hospital. Treatment adherence questionnaire was completed for both groups, one and three months after the intervention. Data analysis was performed in SPSS V21.

In intervention group, treatment adherence score was 56.22 ± 12.98 one month after the intervention, which increased to 61.22 ± 11.51 after three months (P<0.05). In control group, the mean score for treatment adherence was 46.97 ± 11.64 after one month and 45.61 ± 12.36 after three months post-intervention, respectively (P=0.04), and the score significantly decreased.

Teach-back training can improve treatment adherence in patients with acute coronary syndrome and nurses can use this method to promote adherence and subsequently improve disease outcomes.

Patients with acute coronary syndrome suffer from severe consequences such as relapse and readmission due to insufficient comprehension of educational content and subsequently failure in treatment adherence. Using some strategies in order to improvement of their knowledge and comprehension about taught content may be effective on disease outcomes. The current study aimed to determine the effect of teach-back education on readmission in patients with acute coronary syndrome.

In this randomized clinical trial, 70 patients with acute coronary syndrome admitted to the cardiology and cardiac care units of two Hospitals in Zahedan were selected conveniently in 2019. Then patients were randomly assigned to intervention and control groups through using color cards. Data collection tools included demographic information form and a form for recording the readmission. Intervention was based on teach-back education method during three sessions of 30-45 minutes individually and 24 hours after admission to the hospital. Three months after the intervention, readmission was assessed. Data analysis was done through descriptive statistics, independent t-test and chi-square test in SPSS21.

Results showed there was no significant difference between two groups in terms of some variables such as age, gender, educational level, marital status and diabetes history (P>0.05). In intervention group,14.3 percent of patients and in control group 37.1 percent reported readmission during three months after the intervention and there was significant difference between the two groups in terms of readmission (P=0.029).

Teach-back education reduces the cases of readmission in patients with acute coronary syndrome. Given the importance of nurses' role in education, this educational method can be used to improve disease outcomes.

Patients hospitalized in intensive care unit are at risk of aspiration and subsequent complications due to factors such as endotracheal tube, mechanical ventilation, and decreased level of consciousness. Aspiration of gastric residuals to the lung is one of the preventable lesions in patients who are feeding by tube and under mechanical ventilation.This study was conducted to determine the effect of designed care Plan on incidence of aspiration in intubated patients in ICU.

In this clinical trial, the study population included intubated and mechanically ventilated patients who hospitalized in two ICUs of educational hospitals in 2016. Seventy eligible patients were randomly allocated through permuted blocks into two groups of 35 each. A designed care Plan consisting of head of bed elevation, abdominal massage, measurement of gastric residual volumes was implemented for 3 days in the morning and evening in intervention group, while the control group only received routine care. PH-metric process was used to test oral secretions to diagnose aspiration of gastric residuals. Data were analyzed using independent T-test and chi-square by SPSS 15.

Before the intervention, aspiration occurred in all patients in both intervention and control groups. On the second day of study, (7.1%) in intervention group and 92.9% in control group were inflicted by aspiration. During third day of study, 100% of control group suffered from aspiration while aspiration did not occur in any patient of intervention group (p<0.0001).

Implementation of a designed care plan including bed elevation, abdominal massage and gastric residual volume measurement had reduced the incidence of aspiration in intubated patients in the ICU, so planning for regular implementation of these preventive programs should be considered in patient care.

Mothers of children with thalassemia as primary caregivers face problems with treatment and care issues. These problems as consequences of child’s illness often lead to inappropriate adaptive behaviors. The aim of this study was to disclose the relationship between caregiver burden and adaptive behaviors in mothers of children with thalassemia.

In this cross-sectional study, 70 mothers of children with thalassemia major who had referred to the Thalassemia Clinic of Ali Asghar Hospital, Zahedan, in 2016 were studied. Data were gathered using a demographic questionnaire, the Coping Health Inventory for Parents (CHIP), and the Caregiver Burden Scale (CBS). The results were analyzed in SPSS 22 using descriptive statistics, Pearson correlation coefficient, and stepwise multiple regression.

The mean scores of mothers’ care burden and adaptive behaviors were 56.92 ± 12.84 and 57.07 ± 19.84, respectively. It was observed that while care burden has a significant inverse relationship with the total score of adaptive behaviors (r = -0.41, p < 0.001), it displays a direct significant relationship with mother's education (r = 0.26 p = 0.05). The results of multiple regression analysis suggested that the two components of adaptive behaviors and mother’s education could predict 18% of changes in mothers’ care burden. 

According to the results, it is recommended to utilize appropriate educational and supportive interventions for improving the mothers' adaptive behaviors and continuous evaluation of these interventions is necessary.

Cardiac rehabilitation programs refer to interventions aimed at stopping the recurrence of coronary artery disease in patients. The purpose of this study was to determine the effect of rehabilitation-education program on risk factors in patients with coronary artery disease.

In this clinical trial study 70 CAD patients who were admitted to coronary care units of Ali-Ebne Abitaleb Hospital, Zahedan were selected using convenience sampling according to the inclusion criteria. Then, they were randomly allocated to the intervention and control groups by using coin flipping. The intervention consisted of a twelve-week training and exercise program. The exercise program included walking sessions at home at least three times a week. Data were collected through using a demographic questionnaire, measuring blood pressure, fasting blood sugar, low-density lipoprotein and high- density lipoprotein. Data were analyzed in SPSS version 21 using independent t-test, paired t-test, and Chi-square test.

The results showed the significant difference between the two groups after the intervention in terms of risk factors. High- density lipoprotein increased and other risk factors such as systolic and diastolic blood pressure, fasting blood sugar and low-density lipoprotein decreased after the intervention.

The cardiac rehabilitation program reduced the systolic and diastolic blood pressure, fasting blood glucose and low density lipoprotein in the intervention group. On the other hand, it increased high density lipoprotein. Therefore, the adjustment of risk factors is evident in patients who received a cardiac rehabilitation program. It is recommended that healthcare providers deploy such interventions and rehabilitation programs which adjust the risk factors, alleviate disease complications, and reduce individual and social costs associated with cardiovascular diseases.

Pain management program can be helpful in patients with loss of consciousness due to decrease in analgesic drugs, prolonged hospital stay; and also decrease in cost of admission, medicine and medical treatment. The current study was done aimed to determine the effect of pain management algorithm on level of consciousness in patients with loss of consciousness .

In this randomized clinical trial study, 90 patients with loss of consciousness under mechanical ventilation were selected through convenience method and were randomly allocated into two groups of 45 people as the intervention and control groups. Pain management algorithm was implemented in intervention group for 24 hours in morning shift between 8-10, evening shift between 15-17 and in the night shift between 22-24. Data collection tools were the demographic information form and Glasgow Coma Scale (GCS) and Behavior Pain Scale (BPS).

. In terms of level of consciousness, there was no significant difference between the two groups after the intervention, but the mean of volume of sedation drugs was significant different between the two groups in morning and night shift (p<0.05)

The use of the pain management algorithm can significantly impact on volume of sedation but has no effect on level of consciousness.

patients with loss of consciousness experience pain concerning the invasive procedures, mechanical ventilation and physical situation of ICU. The current study was conducted to determine the effect of instrumental music on pain intensity in patients with loss of consciousness in intensive care unit.
In this clinical trial study, study population was the intubated patients under mechanical ventilation who hospitalized in intensive care unit in one of the hospitals in Zahedan 2015. 60 eligible patients were selected conveniently and then were randomly allocated through permuted blocks into two music therapy and control groups of 30 persons. Intervention was carried out through playing instrumental music of Arnd Stein in 3 sessions of 30 minutes via headphone. Control group only received the routine care about pain relief. Measuring the pain was done through BPS, 5 minutes before and immediately after the music therapy. In control group, measurement was done with the same interval and frequency. Data were analyzed in SPSS 15 and using independent T-test, paired T-test, chi-square and ANCOVA.
Every three days after the intervention, the mean score of pain was significantly reduced in intervention group (p According to results, the application of instrumental music can reduce the intensity of pain in patients with loss of consciousness. Thus, it can be used as a simple, practical and low costs method in pain relief of patients with loss of consciousness in the intensive care unit.

Appropriate clinical environment has an important role in preparing students to use learned knowledge in practice through providing learning opportunities. Since the students’ experiences in the clinical setting affect on quality of their learning، the current study aimed to explain the experiences of nursing students concerning clinical education setting. The current study was conducted based on conventional content analysis. Sampling was done purposively and the participants were 13 last year nursing students in Zabol Nursing and Midwifery School in 2013-2014. Data collection was done through in-depth semi-structured interviews. Data analysis was conducted through qualitative content analysis approach. Based on the results، five major categories including threats، vision، dual forces، mindset and students’ action to clinical education and also10 subcategorie were identified. Since the formation of students’ experiences in these environments is one of the predictive factors in achieving their learning and in facilitating the professionalization process، thus; the attention of managers in clinical settings is very important for decreasing the threats and concerns for students. In this way، the marred prospects of profession can be recovered through the meeting students’ expectations، attractiveness of the profession can be increased and the positive belief، actions and feelings can be created in students.

Although it is generally acknowledged that symbolic interactionism and grounded theory are connected، the precise nature of their connection remains implicit and unexplained in reviewed articles. Awareness of the nature of their connection can help qualitative researchers as guidance for data collection and analysis. This study was accomplished with the aim of exploration of the connection between grounded theory and symbolic interactionism.

The search of related articles and resources was done in databases such as Scopus، Elsevier، Google Scholar، and ProQuest and with keywords including grounded theory، symbolic interactionism، and methodology. Then the selected articles were reviewed.

In this study، researchers، by reviewing of related articles، have propounded the connection between methodological principles and processes of Blumer in the symbolic interactionism with grounded theory. Then، they have argued about the explanatory power of symbolic interactionism as a philosophical basis in a grounded theory study in the explanation of student-teacher relationship in clinical nursing education.

When the grounded theory study is undertaken without a symbolic interactionism framework as an explanatory framework، the researcher describes rather than explains the data.

Participation of men in family planning programs a range of different activities and in fact one of the factors of success in increasing family planning program is. The aim of the present study is detecting relevant factors of male participation in family planning in teachers in zahedan. In this cross-sectional descriptive analytical study,250 male teachers were studied.Teachers who are Married and wanted to share were chosen.The 4-part questioner include demographic data, participation, knowledge and attitude was used. 77.6 percent participated in family planning. Special male methods were used by 62.4 percent of them and use of kandom had higher rate. Results showed that only the people who mean marriage age was higher,had more participation in Contraceptive methods. So that the people who mean marriage age of 26/78 had more participation that those of their mean age was 25/36 and T test shows significant difference(P=0.017). There was no significant relationship between participation and other factors. According to findings, male teachers participated in family planning.because of their poor knowledge, they need to be instructed by instructive programs related to family planning methods.