Journal of Hayat

Impact of Two Types of Sodium and Ultra Filtration Profiles on Systolic and Diastolic Blood Pressure in patients during Hemodialysis

M Ghafourifard

Background & Aim: Intradialytic hypotension is the most frequent complicationin patients receiving haemodialysis (HD). This complication not only contributes to the illness of the patients, but also decreases the efficacy of the HD. So, hypotension prevention is a major challenge for medical team, especially for nurses. One of the preventive methods that have recently been presented is the use of sodiumprofile and ultra filtration (UF) profile. The aim of thisstudy was to compare the effects of linear sodium + UF profile (type1) with stepwise sodium + UF profile (type3) on systolic and diastolic blood pressure in HD patients.

Methods & Materials: In this crossover design study, 26 HD patients from two dialysis centers at Esfahan Universityunderwent three kinds of treatment: (1) control, constant dialysate sodiumconcentration of 138 mmol/L with constant UF (2) linearsodium profile + UF profile (type1), a linearly decreasing dialysate sodium concentration (146-138mmol/L) in combination with a linearly decreasingUF rate and (3) stepwise sodium profile + UF profile (type2), a stepwise decreasing dialysate sodium concentration (146-138mmol/L) in combination with a stepwise decreasingUF rate. Eachtreatment was applied in three dialysis sessions. Data were analyzed using repeated measure ANOVA test in the SPSS.

Results: Twenty six patients participated in the study. A total of 234 dialysis sessions were analyzed. There were no significant differences in the systolic blood pressure between three groups during predialysis and first and the second hours (P>0.05). The mean of systolic blood pressures were higher in the third hour and postdialysis during two types of profiles (1&3) compared with the routine care group (P<0.05). The mean of diastolic blood pressure was also higher in postdialysis during two types of profiles (1&3) compared with the routine group (P<0.05). There was no significant difference between the profiles 1and 3 (P>0.05).

Conclusion: In conclusion, sodium profile + UF profile is a simple and cost-effective method that modulate the dialysate sodium and ultra filtration rate and preserve the homodynamic status and blood pressure of patients during dialysis. Therefore, using sodium profile + UF profile (type1 & type3) is recommended in order to prevent hypotension and reduce nursing work during hemodialysis process.

Protecting Patients' Privacy by Medical Team and Its Relation to Patients' Satisfaction

M Aghajani

Background & Objective: Privacy is a basic humanity principle. Protecting patients&apos privacy is a necessity in health care organizations and along with the patients&apos satisfaction, is one of the main indicators of quality of care. The objective of this study was to assess patients&apos privacy protecting by medical staff and its relation to patients&apos satisfaction.

Methods & Materials: This is a cross-sectional survey in which 360 inpatients were recruited using convenience sampling method from an emergency department. Data were collected using a questionnaire and were analyzed using statistical tests in the SPSS.

Results: According to the results, about one half of the patients reported poor privacy protecting and one other half (49.4%) reported that their privacy was protected "relatively good" to "good". A strong correlation was found between level of privacy protected and the patients&apos satisfaction in various dimensions. There was significant correlation between some of demographic variables with privacy protecting and patients&apos satisfaction.

Conclusion: In our study, protecting patients&apos privacy and also patients&apos satisfaction was not generally appropriate. More attempts of clinicians are required to improve the quality of care to promote patients&apos privacy as well as patients&apos satisfaction.

Nursing as an Art

M Salsali

In the many definitions that are accompanied with nursing, in addition to the scientific aspect, art has always been mentioned. Since Florence Nightingale introduced nursing as an art, several theorists have emphasized the aesthetic aspect of nursing in their literature. However, many experts believe that the word "art" has been accepted in nursing without deep thought and criticism.To judge the statement: "Nursing is an art", it seems that it is necessary to review the similarities and differences of "art" concept in nursing and other fields literature. Art has a complex and multidimensional meaning that is the backbone of many theories presented however, they each have their own strengths and weaknesses. Nursing has artistic properties but this characteristic is referred to as folk art and not to specific features of art. In comparing these theories with the concept of art used in nursing, it is essential to note that art in nursing refers to skills of nursing. In other words, nursing is not a kind of fine art.From the aesthetic perspective, nursing can be easily defined as a form of art however, we must put great importance in the inseparable words of "aesthetic" and "art of nursing". With such a connection, we are able to introduce and capture the true spirit of both art and nursing. In this article, we have reviewed the most important definitions and theories of art as a "specific term", and as "skill", where they have linked nursing to art. Moreover, we have discussed their similarities and differences.

The Effect of Slow Stroke Back Massages on Anxiety among Primigravid Women

MR Bazrafshan

Background & Objective: Pregnancy is a situational crisis in women&aposs lives that is potentially related to anxiety. Massage, a kind of relaxation technique, is a non-pharmacological intervention for anxiety relief. Slow stroke back massage is an independent nursing procedure that is closely associated with the caring nature of nursing. This study aimed to assess the effect of slow stroke back massages on anxiety level among primigravid women in two clinics in Shiraz in 2007.
Methods & Materials: In this clinical trial, 80 primigravid women aged 15-35 who were in the 3^rd trimester of pregnancy were enrolled in the study. The participants were randomly allocated in the intervention and control groups. The intervention group received slow stroke back massage for 10 minutes in three consecutive mornings. Anxiety level was measured before and immediately after the intervention in both groups. Data were gathered using the state anxiety Spielberger questionnaire and were analyzed using Chi-square test, Fisher&aposs Exact test, Paired t-test, and Independent statistic test (t-test).
Results: The means of the anxiety level were 51±6.6 and 49.90±6.6 at baseline in the intervention and control groups, respectively (P=0.460). After the intervention, the means of anxiety level were 48.18±6.52 and 51.50±7.39 in the intervention and control groups, respectively (P=0.036).
Conclusion: According to the results, slow stroke back massage seems to be an effective nursing intervention for anxiety relief in primigravid women. It provides an opportunity for nurses to offer individualized and holistic patient care.

Effect of Subcutaneous Injection of Sterile Water on Labor Pain, Type of Labor, and Satisfaction with Pain Management in Nulliparous Women

L Hosseini

Background & Objective: Labor pain is usually the most severe pain women experience in their lives. Most women suffer from low back pain during first stage of labor. The pain can produce adverse effects on delivery procedure. Because of potential side effects of medications used in labor, alternative methods for pain relief have received more attention nowadays. The aim of this study was to evaluate the effect of subcutaneous injection of sterile water on labor pain, type of labor, and satisfaction with pain management in nulliparous women.
Methods & Materials: This was a randomized single-blind study. Samples were consisted of 80 women who were randomly allocated to two intervention and control groups. In the intervention group (40 women) sterile water was injected subcutaneously in four sacral regions during first stage of labor. In the control group, we just inserted a needle in the same area. Low back pain intensity was assessed before and 10, 45, and 90 minutes after the injections using visual scales in both groups. Data were analyzed using descriptive (relative & absolute frequencies, mean and standard deviation) and inferential statistics (t-test, paired t-test and c²) in the SPSS.
Results: There was no significant difference between two groups at baseline. The mean of pain intensity in 10 and 45 minutes after the injection was decreased significantly in the intervention group (P=0.00). There was no significant difference between two groups in the 90^th minute. There was no difference in the type of labor between two groups. The mean of the satisfaction score was higher in the intervention group than in the control one.
Conclusion: It seems that subcutaneous sacral injection of sterile water might be an effective and safe method to alleviate labor pain in women

Planning and Evaluation of an Educational Program Based on PRECEDE Model to Improve Physical Activity in Female Students

F Estebsari

Background & Objective: Physical activity is one of the main components of lifestyle. Lack of physical activity along with unhealthy eating result in chronic diseases such as heart diseases, diabetes, and osteoporosis. This study aimed to design an educational program for improving physical activity in secondary school female students in Tonkabon in 2008.
Methods & Materials: This study was an educational intervention in which 600 students enrolled in the study. The participants were allocated randomly in the intervention (n=300) and control (n=300) groups. Data were gathered using "International Physical Activity Questionnaire" and a standardized questionnaire -according to PRECEDE model- at baseline. The program was planned according to the PRECEDE model and was implemented in the intervention group students. Data were gathered two months after the intervention in both groups. Data were analyzed using Chi-Square, t-test, variance and regression analysis tests in the SPSS and STATA.
Results: Following the educational intervention, the mean scores of the predisposing factors (knowledge and attitude), enabling factors, and reinforcing factors as well as the behavior were significantly increased in the intervention group compared to the control group (P<0.001).
Conclusion: The findings showed that this structured program is useful in improving physical activity in female students.

Effect of an Aerobic Exercise Program on Fetal Growth in Pregnant Women

NS Motahari Tabari

Background & Aim: Exercise is an integral component of physical and mental health. Attention to exercise in women, regarding their physiologic situation is essential. This study aimed to investigate the effect of a specific aerobic exercise program on fetal growth in pregnant women.
Methods & Materials: In this clinical trial, 39 pregnant women in 24-32 weeks of gestation were enrolled. The participants were randomly allocated to experimental (n=18) and control (n=21) groups. Women with single pregnancies and intact amniotic membranes were included. Women who had any contraindications for exercise were excluded from the study. Exercise program included stretching and flexibility exercise and aerobic exercise (constant walking for 30-45 minuets) three days a week for eight weeks. Data were analyzed using descriptive statistics, c², t-test, Kolmogro-smirnov and repeated measurements. P<0.05 was considered to be significant.
Results: The results showed a 1.37% increase in the newborns&apos weight in the intervention group however, the difference was not statistically significant. The average of head circumference and newborns&apos length in the intervention group&aposs newborns were 0.21cm and 0.09cm more than the control group&aposs newborns, respectively. These differences were not statistically significant too (P>0.05).
Conclusion: There were no reductions in the growth of the fetuses following the exercise activities. This kind of exercise has no adverse effect on fetal growth.

Effect of Reflexology on Anxiety Level in Nuliparous Women

F Mirzaee

Background & Objective: Labor potentially causes stress and anxiety, especially in nulliparous women. In Iran, many pregnant women undergo cesarean section electively due to fear of labor pain. The purpose of this study was to investigate the effect of reflexology on the anxiety level, blood pressure, and pulse in nulliparous women in Kerman.
Methods & Materials: In this clinical trial, 70 nulliparous women with gestational age more than 37 weeks and cervical dilatation of 3-4 cm were recruited for the study. The participants were randomly allocated to two equal reflexology and control groups. The reflexology group received the intervention for 20 minutes (each foot: 10 minutes) on their feet and the control group received massage for 20 minutes on their legs. Anxiety level, blood pressure and pulse rate were measured at baseline and immediately after the intervention using Spielberger questionnaire.
Results: Anxiety level did not differ between the two groups at baseline (P=0.85). After the intervention, the mean of anxiety level was significantly lower in the reflexology group than in the control one (P<0.001). The pulse rate (P=0.44) and blood pressure (P=0.59) did not differ significantly in two study groups after the intervention.
Conclusion: Reflexology reduced anxiety level in labor.