Evidence Based Care
Volume:10 Issue: 2, Summer 2020

Strengthening the coping resources as an instruction for anxiety-regulation may affect the emotion-regulation of families. Regarding the significant role of families in health of these patients, it seems that interference in strengthening coping resources affects their emotion-regulation.

This study aimed to determine the effect of strengthening family coping resources on the emotion-regulation of schizophrenic patients' caregivers.  

This quasi-experimental research was conducted on families with hospitalized schizophrenic patients in one of the most prominent psychiatric centers in the Northeast of Iran in 2018. The participants were assigned to intervention (n=29) and control (n=31) groups. A short revised form of Emotion-Regulation Questionnaire was utilized as data collection tool. The intervention based on strengthening family coping resources (SFCR) was administered in three modules and 15 group sessions (groups of 6-8 individuals) according to the instructions of the multi-family model of Kisser et al. On the other hand, the controls received routine cares in hospital wards.The data were analyzed in SPSS software version (16) using independent and paired t-tests.

The groups were homogenous in terms of demographic characteristics. The result of independent t-test demonstrated a significant difference in the mean score of revaluation (P=0.001) and suppression (p=0.001) in the intervention group, compared to the control group, after the intervention.

This intervention can guide clinicians on how to implement a family-centered care program to reduce the burden of caring schizophrenic patients through gaining family support in the efficient care of these patients.

Spinal anesthesia is the most prevalent anesthetic method used for transurethral resection of the prostate (TURP) surgery. Lower motor block and fewer side effects can be achieved by lower doses of anesthesia.

The present study aimed to compare the effects of Spinal anesthesia with a low dose of hyperbaric bupivacaine plus fentanyl with hyperbaric bupivacaine for TURP surgery on hemodynamic effects, duration of analgesia, and Motor block.

This randomized-controlled study was conducted on 62 patients undergoing TURP surgery within 2017-18. BF group received 0.5% hyperbaric bupivacaine(1mg) 0.2 ml+fentanyl (20µg) 0.4 ml+5% dextrose 1.4ml, while B group received 0.5% hyperbaric bupivacaine (10mg)2ml. Bromage scale and Visual Analog Scale of pain and Nausea were used. The obtained data were analyzed in SPSS software version (20).

Groups were homogenous in terms of demographic characteristics. The time to reach the sensory level of T10 was significantly longer in the BF group, compared to the B group (P<0.001). The motor block score was less in the BF group than the B group. The mean total recovery time of the sensory block to L5 in the BF group was significantly lower than that of the BF group (P<0.001). The mean score of nausea severity during surgery was significantly lower in the BF group, compared to the B group (P=0.02). The hemodynamic stability was higher in the BF group.

A combination of 1mg bupivacaine with 20μg fentanyl could be used for anesthesia in TURP surgery as an effective method to provide sufficient analgesic effects, as well as lower motor block and side effects.

The elderly health care services provided in public health centers neglect the care and education of the healthy elderly.

This qualitative study aimed to improve the quality of public health services for the healthy elderly.

This participatory action research was conducted on 11 health care workers, 54 elderly participants, and 54 family members in Motahhari Comprehensive Health Services Center of Mashhad, Iran, within 2016-2019. Data collection tools were the SERVQUAL questionnaire, interview, focus group discussion, and field note-taking. After the identification of the problems through interviews with participants, the sessions of focus group discussions were held to design the program. After executing the change programs, evaluations were repeated to compare pre-change and post-change situations. Qualitative content analysis was performed using the reality description method, and quantitative content analysis was conducted by descriptive statistics and paired t-test.

The mean values of age and work experience of the health care workers were reported as 32.4±2.7 and 8.1±1.7 years, respectively. Using the developed care files, the non-specialist routine care was transformed into standardized organized care based on the needs of the healthy elderly. In the pre-intervention phase, the mean scores of service quality from the perspective of the elderly participants and their families were 63.0±9.4 and 61.8±9.0, respectively. In the post-intervention phase, the aforementioned figures statistically increased (P=0.001) to 130.1±14.7 and 122.6±13.5, respectively.

The quality of health care services for the healthy elderly improved by encouraging the participation of the elderly and their families in the care process. This approach can be used in other public health centers.

Patients are meticulous supervisors of their self-care. Their perceptions and experiences play a significant role in their awareness of the overt and covert problems in the healthcare settings. However, few studies have focused on the exact details of the nature of safety experienced only by the patients.

This study aimed to carry out the conventional content analysis of patients’ feelings of safety during hospitalization.

This qualitative study was conducted on a total of 31 patients hospitalized in various wards of hospitals affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran, using purposive sampling in 2019. The data, obtained through semi-structured interviews, were analyzed by conventional content analysis using Graneheim and Lundman’s approach (2004) with MAXQDA software (version 2010).

Finally, data analysis resulted in the establishment of three main categories, namely feeling of insecurity, insolvency, and seeking safety and security.

The obtained results of the present study can be helpful in designing a patient-based care program focusing on patient safety. The healthcare team can improve patient care through the consideration of factors contributing to the feeling of safety in patients.

Fatigue is one of the outcomes of reduced dialysis adequacy (DA) in patients undergoing hemodialysis (HD). Accordingly, increased blood flow velocity (BFV) can be one of the strategies to enhance DA and reduce fatigue. This study aimed to determine the effect of increased BFV on fatigue in HD patients. This two-group randomized clinical trial was conducted on 74 HD patients attending 17-Shahrivar Hospital and Shafa Dialysis Center, Mashhad, Iran, during 2018. The intervention group was subjected to 25 and 50 rounds, which were added to the mean value calculated for dialysis machine velocity. Considering the control group, the rounds of the machine were set as those mean of the first two sessions. Fatigue was measured using the standardized Multidimensional Fatigue Inventory. The blood urea nitrogen (BUN) level and DA were analyzed after the 1st, 8th, and 14th sessions. The data were analyzed in SPSS software (version 16) through independent t-test, repeated measures analysis of variance (ANOVA), Mann-Whitney U test, and Chi-square test. The mean ages of the control and intervention groups were 57.16±13.81 and 55.86±13.56 years, respectively. The results of repeated measures ANOVA showed that fatigue in the intervention group had significantly dropped during HD sessions, compared to the control group. Moreover, these patients obtained better DA (P˂0.001). Implications for Practice: Increased BFV of the dialysis machine leads to improved DA, BUN removal, and reduced fatigue in HD patients, which can be recommended to nurses as an effective strategy.

The scoring systems evaluate neonatal outcomes based on perinatal factors in the Neonatal Intense Course Unit (NICU). This study aimed to predict mortality risk in preterm neonates for the first time, using the Clinical Risk Index for Babies (CRIB II). This cross-sectional, descriptive-analytical, longitudinal study was conducted on 344 preterm neonates with the gestational age of 23-32 weeks and birth weight of 500-1500 g in a referral center in Tehran, Iran, from winter 2016 to spring 2017. Some neonatal variables were completed within the first 12 h of life, and the final scores were calculated based on CRIB II. Then, the correlation of these variables with mortality outcome was evaluated using logistic regression. Sensitivity, specificity, and positive and negative values were also calculated via SPSS software (version 23). According to the results, 253 (73.57%) neonates, including 122 girls (48%), survived in the first 24 h after birth. The total CRIB II score in the surviving neonates was 6.1±2.6. The area under the receiver operating characteristic curve was estimated at 0.84 with the cut-off point of 8.5. In addition, the sensitivity, specificity, positive predictive value, and negative predictive value of the CRIB II system were obtained as 75%, 78%, 55%, and 89.5%, respectively. The results revealed a significant correlation between the CRIB II score and mortality outcome. In this regard, an increase in the CRIB score coincided with a 0.67 increase in the risk of death (OR=1.671, p <0.001). Implications for Practice: Based on the findings of the present study,CRIB II can be concluded to be an appropriate scoring system. Consequently, the result of this tool can be used for routine investigations.

Multimedia learning can be recommended for cardiopulmonary rehabilitation to reduce respiratory complications following open-heart surgery (OHS). Furthermore, flipped learning may reinforce the effects of education via further feedback.

This study aimed to compare the effects of flipped teaching versus multimedia-based teaching on postoperative physical activity in patients undergoing OHS.

This controlled randomized clinical trial was conducted on a total of 60 patients admitted to an intensive care unit and a cardiac-surgical ward in northeastern Iran in 2019. In the multimedia learning group, a tutorial video was displayed three times a day at different stages, namely preoperation, 1-2 days after the surgery, and 2-3 days postsurgery. The flipped learning group was also subjected to the same tutorial with the potential to be displayed on smartphones. Then, the 6-Clicks instrument was completed to assess the basic mobility function. The data were analyzed in the IBM SPSS Statistics software (version 25) using the Mann-Whitney U and Friedman tests.

The groups were homogenous in terms of demographic characteristics. The mean duration of physical activity was not significantly different in the study groups at the preoperative stage (P=0.87), 2 days postoperation (P=0.09), and 5-6 days after surgery (P=0.10). Based on the inter-group comparison, the mean score of physical activity was significantly different between the groups receiving flipped (P<0.001) and multimedia (P<0.001) learning.

The same as multimedia learning, flipped learning is able to improve physical activity in patients following OHS.

Receiving the news of a loved one’s death can cause extreme anxiety reactions. Breaking death news according to the setting, patient perception, invitation, knowledge, empathy, and strategy (SPIKES) protocol could be effective in alleviating this anxiety. This study aimed to determine the effect of using the SPIKES protocol for delivering the news of patient mortality to the deceased’s family members on their anxiety symptoms. This non-randomized controlled intervention study was carried out on the 60 families of the patients who died in Imam Reza Hospital of Mashhad, Iran. The subjects (i.e., next of kin or close family members) were divided into two groups of 30 cases. In the control group, the nurse conveyed the news of death using her routine method. In the intervention group, this task was performed according to the SPIKES protocol. After delivering the news, the nurse assessed the level of anxiety in the recipient of the news by filling out an inventory of visual symptoms of anxiety. The Mann-Whitney U test showed that the mean anxiety score in the intervention group (31.2±11.7) was significantly lower than that of the control group (63.4±18.1) (p <0.001). Since the findings revealed that the SPIKES protocol reduced the level of anxiety in the recipients of bad news, it is essential to apply this protocol in nurse education and training courses in Iran.