---

Background & Aim: It is important to measure the anxiety level in patients who undergo heart surgery and find out ways to relief it. This study aimed to determine the effect of cardiac rehabilitation program's first phase on the level of anxiety among patients hospitalized for coronary arteries bypass surgery.

Methods & Materials: In this randomized clinical trial, sixty patients were selected using block sampling and randomly allocated into experimental and control groups. Data were gathered using a questionnaire including the spiel burger's standardized questionnaire. The level of anxiety was measured in both groups. Then, the first phase of cardiac rehabilitation program (including physical exercise, and daily living activities) was carried out in the experimental group. Finally, patients in the experimental group discussed their experiences of surgery. Control group Patients received usual care. The level of anxiety was measured in both groups the day before surgery and at the time of discharge. Data were analyzed using t-test, chi-square, and Friedman tests in SPSS.

Results: Findings showed that the level of anxiety had no significant differences between two groups at the time of admission. After implementing the rehabilitation program, the level of anxiety decreased significantly (P<0.001) in the experimental group. Significant differences were observed in the level of anxiety between two groups after intervention (P=0.015) and at the time of discharge (P=0.038).

Conclusion: This procedure should be used in surgery patients

---

Background & Aim: The aim of this study was to investigate the relationship between nurses&apos knowledge about pain and satisfaction from pain relieving procedures among postoperative CABG patients in selected Tehran medical university hospitals.

Methods & Materials: In this cross-sectional study, 100 nurses were recruited from the ICU Open heart. Also, 200 patients were selected from whom underwent CABG in 24 hours after surgery and were extubated using a simple random sampling method. Data were gathered using two questionnaires including 17 question about demographic characteristics of patients and their satisfaction, and 36 questions about demographic characteristics and nurses&apos knowledge about pain and pain control after the CABG. Data were analyzed using descriptive and inferential methods using SPSS-11.5.

Results: There was not significant relationship between the nurses&apos pain knowledge and the patients&apos satisfaction. However, there were a significant relationship between the knowledge of the nurses about pain control after the CABG and the patients satisfactions (r=0.209, P=0.037).

Conclusion: According to the findings of the study, there were some significant relationships between the nurses demographic and pain knowledge with the pain control after the CABG. There was also significant relationship between patients&apos satisfaction and some of them demographic characteristics.

---

Background & Aim: The presence of pain is a common phenomenon among patients in critical care units. Critically ill patients are often unable to communicate because of illness or sedation so, recognition and assessment of their pain is difficult. In these patients, observational behavioral indices can be used to evaluate pain. The aim of this study was to investigate the effect of application of critical-care pain observation tool in patients with decreased level of consciousness on performance of nurses in documentation and reassessment of pain after palliative intervention.

Methods & Materials: In this before and after quasi-experimental study, 106 nurses working in general intensive care units in selected hospitals affiliated to Tehran University of Medical Sciences were selected. First, we examined the nurses&apos performance three times in relation to documentation and reassessment of pain after palliative intervention, position change and suction procedure in patients with decreased level of consciousness using a researcher-made check list. Then, we taught nurses individually, how to use this tool to investigate the pain of patient in a session lasting an hour. A week after the training, the researcher reevaluated performance of trained nurses in relation to documentation and reassessment of pain after palliative intervention in patients with decreased level of consciousness. Finally, those data collected before and after the training of the CPOT to nurses were compared using the Wilcoxon test.

Results: Findings showed that the CPOT could not lead to improved nurses&apos function in relation to documentation of pain in the patients records (P=0.209) and recording palliative measures related to pain (P=0.117). However, there were significant statistical differences between nurses&apos function in relation to reassessment of pain after palliative intervention, before and after the training and application of the CPOT. Comparing the mean function scores before and after the intervention, demonstrated that the performance of nurses in this area has been improved after the intervention.

Conclusion: The critical-care pain observation tool can increase nurses&apos sensitivity to pain in patients with decreased level of consciousness. It forces the nurses to reassess the pain after palliative intervention. This tool does not motivate in nurses to document pain palliative process. So it is recommended that future studies investigate the impact of this tool on other aspects of pain management, such as diagnosis of pain and using of drugs and non-drug measures.

---

Background & Aim: Poor sleep quality is a common problem among patients hospitalized in the CCUs. This study aimed to determine the effect of environmental factors modification strategies on quality of sleep among patients admitted to CCU.

Methods & Materials: This was a quasi-experimental study with a single-blinded design. Sixty patients admitted to the CCU of Shariati hospital were divided into two experiment and control groups. Sleep quality was measured in the first day of admission and three days later using the Pittsburgh sleep quality index in both groups. In the intervention group, we implemented a modified work environment between the two measurements. Data were analyzed using the Chi-squared and t-test in the SPSS v.18.

Results: Findings showed a significant decrease in sleep quality in the control group after hospitalization, compared with the intervention group (P<0.001). There were no statistically significant changes in the sleep quality before and after hospitalization in the intervention group (P=0.053).

Conclusion: Using environmental factors mitigation strategies can improve sleep quality of patients admitted to CCUs.

 

---

  Background & Aim: Reducing maternal anxiety has a critical role in maternal and fetal mental and physical health. This study aimed to assess the effect of two anxiety reducing techniques including relaxation and maternal-fetal attachment training on anxiety in third trimester and postpartum depression among primipara women.

  Methods & Materials: In this clinical trial, 126 pregnant women were randomly selected and divided into three groups including relaxation training, maternal-fetal attachment skills training, and control group. The participants completed a demographic questionnaire, the Spillberger and Beck questionnaires and written consents at baseline. The participants completed the questionnaires after the intervention too. The one way ANOVA and paired t-test were used to analyze the data. 

  Results: At baseline, the mean total anxiety, state and trait anxiety and depression scores were not significantly different between the groups. The ANOVA showed differences in the mean score of anxiety after the intervention (P=0.03) in the intervention groups. There were statistically significant differences between the attachment and control groups (P=0.01) and the relaxation and control groups (P<0.001) in terms of the mean score of state anxiety. The ANOVA showed a reduction in the mean score of state anxiety after intervention in the attachment (P=0.02) and relaxation groups (P=0.01). There was significant difference after the intervention in the mean score of maternal depression (P=0.002) between the attachment and relaxation groups with the control group (P=0.01, P=0.01 respectively). 

  Conclusion: A ttachment and relaxation trainings can reduce maternal anxiety and post-partum depression. Pregnancy visit is an important opportunity to screen maternal anxiety and prevent post-partum depression using simple and non-expensive training programs.

---

  Background & Aim: The ventilator associated pneumonia is a common problem in critical care units. It is associated with increased mortality, cost and length of stay. Nurses have great role in preventing the ventilator associated pneumonia. The aim of this study was to assess nurses' performance in prevention of ventilator associated pneumonia .

  Methods & Materials: In this descriptive study, 110 nurses working in selected hospitals affiliated to Tehran University of Medical Sciences were selected using convenience sampling method. A 32-item observational checklist was provided based on the ventilator associated pneumonia prevention guideline. The nurses' performance was observed three times. Data were analyzed using descriptive statistics in the SPSS-16 . 

  Results: This study showed that the mean score of the nurses' prevention was 46.8±5.79. Most of the nurses (66.4%) had poor performance and 36.6% had relatively good performance. There were no nurses with favorable performance in the prevention of ventilator associated pneumonia. The highest score was in contact precaution (72±9.67) and the lowest score was in mouth hygiene (18.78 ± 17.4) .

  Conclusion: The majority of nurses had poor performance in prevention of ventilator associated pneumonia. More attention should be paid for planning appropriate training programs for nurses and giving adequate facilities to improve health care quality .

  

---

  Background & Aim: Lack of knowledge about acute myocardial infarction and its treatment result in feeling anxious among the patients. Implementing appropriate educational methods can decrease anxiety in patients with acute myocardial infarction. This study was conducted to compare effects of two educational methods (face-to-face and electronic educational methods) on anxiety among patients with acute myocardial infarction .

  Methods & Materials: This was an experimental study in which 105 patients hospitalized with acute myocardial infarction in the "CCUs" of three educational hospitals were selected based on eligibility criteria and were allocated into three groups including face-to-face educational group, electronic education group, and control group using block randomized allocation. Data were collected using demographic check-list and the Spielberger state-trait anxiety inventory questionnaire. The level of anxiety was measured before and immediately after the interventions in all three groups. Data were analyzed in the SPSS-16.

  Results: Both educational methods reduced anxiety significantly in patients with acute myocardial infarction. There were no significant difference between the two educational method groups in the anxiety level (P=0.94) .

  Conclusion: Both face-to-face and electronic educational methods reduced anxiety in patients with acute myocardial infarction. It is recommended that nurses use one of these educational methods to reduce anxiety among the patients .

  

---

  Background & Aim: Medication usage is the bases of disease management in patients who undergo hemodialysis. Non-adherence to medication regimen increases the incidence of complications among the patients . The aim of this study was to investigate the effect of a cognitive-behavioral intervention on medication adherence in patients undergoing hemodialysis .

  Methods & Materials: In this clinical trial, 70 patients were selected from Imam Reza and Valiasr hospitals. Patients were assigned into two intervention (n=35) and control (n=35) groups. The intervention group received a cognitive-behavioral intervention including six steps: 1) Identifying the problem 2) Creating confidence and commitment 3) Increasing awareness of behavior 4) Developing and implementing the action plan 5) Evaluating the plan and 6) Maintaining the desired behavior. Adherence to medication regimen was assessed using a self-report questionnaire before and immediately after the intervention. Data were analyzed using the independent t-test . 

  Results: At baseline, there was no significant difference in adherence to medicine regimen between the intervention (20.77 ± 4.56) and control (22.34 ± 3.65) groups (P=0.1). After the intervention, significant difference was observed between the two groups in adherence to medication regimen (P<0.001) .

  Conclusion: Cognitive–behavioral intervention could improve medication adherence in patients undergoing hemodialysis. It is recommended for nurses to use this approach to improve medical care among the patients .

  

---

  Background & Aim: Family caregivers play major role in caring for the patients with dementia. Meanwhile, they are at risks of various diseases. Caring for a person with Alzheimer’s disease carries a significant physical, socioeconomic and psychological burden. This study described the impact of cognitive-behavioral management on burden and problems borne by family caregivers of patients with Alzheimer's disease .

  Methods & Materials: This non-randomized controlled clinical trial was conducted on 70 family caregivers of patients with Alzheimer’s disease. The participants were subjected to experimental and control groups. The Zarit Burden Interview was used to assess the burden experienced by family caregivers of the patients. Data were then analyzed using inferential and descriptive statistical parameters (mean and SD) and paired sample t-test on the difference between the scores of pre-test and post-test . 

  Results: The mean level of caregivers’ burden as measured by ZBI was 44.56± 6.77 and 42.57±5.98, in experimental and control groups before intervention respectively. Caregivers’ burden score was 39.54±5.88 and 44.86±5.87, in experimental and control groups after intervention respectively. Results showed a significant decrease in the training group’s score (P<0.001) .

  Conclusion: Given the obtained results indicating the effectiveness of cognitive- behavioral management in reduction of caregivers’ burden, the present study can be helpful in achieving an effective solution to decrease stress among family caregivers of patients who suffer from Alzheimer's disease .

  

---

Background & Aim: Violence against women is a serious social problem affecting public health. Given the relatively high prevalence of domestic violence and the need for screening, a simple tool for its correct diagnosis in a short time seems to be necessary. This study aimed to compare the diagnostic values of the HITS (Hurts, Insults, Threaten, and Screams) tool and CTS2 (Revised Conflict Tactics Scales) in domestic violence screening.

Methods & Materials: This cross-sectional study was conducted on 279 married women referred to health centers in Tabriz in 2014. Data were collected using the socio-demographic questionnaire, HITS and CTS2. Kappa index was used to assess agreement between instruments.

Results: Results showed that HITS tool had relatively good sensitivity (75.7%) and high specificity (93.5%). Positive predictive value and negative predictive value were 96.8% and 59.5% respectively. There was a moderate agreement between instruments (Kappa=0.6).

Conclusion: Given the simplicity of HITS and the possibility to complete it in a short time, this questionnaire can be recommended to identify people experiencing domestic violence at the broad level. In addition, the development of this tool is recommended in future studies.

---

Background & Aim: Nowadays, home-based cardiac rehabilitation (HBCR) program is one of the major methods that can improve the quality of life of patients following coronary artery bypass graft surgery. The present study aimed to investigate the effect of a HBCR on the quality of life of patients following CABG.
Methods & Materials: In this clinical trial, 104 inpatients at Golestan and Imam Khomeini hospitals in Ahvaz in 2017, based on permuted-block randomization were assigned to an intervention or a control group. The intervention group received four training sessions for four days at the hospital and then six sessions of home-based cardiac rehabilitation (at 2-week intervals for three months). The Mac-New quality of life questionnaire was completed by the intervention and control groups before the surgery and three months after CABG surgery. Data were analyzed using the SPSS software version 22.
Results: The postoperative mean scores for quality of life subscales and for overall quality of life in the intervention group were greater compared to the control group (P<0.001). The obtained effect sizes were 1.17 for the emotional, 1.42 for the physical, and 1.91 for the social subscales and 1.67 for the overall quality of life. The Eta-squared value (0.408) indicated that the effect of the home-based cardiac rehabilitation program on the quality of life was significant (P<0.0001).
Conclusion: The study findings suggest that the home-based cardiac rehabilitation program has positive effects on the various subscales of quality of life. HBCR is recommended as a cost-effective care model for all patients attending heart surgery centers.
Clinical trial registry: IRCT20171114037468N1
 
 

---

Background & Aim: Physical activity is a health behavior that helps one's mental and general health, improves the health of women during preconception period and reduces pregnancy and birth complications. The aim of this study was to predict physical activity based on the BASNEF model constructs during preconception period among women referred to Uremia health centers.
Methods & Materials: This cross-sectional study was conducted on 230 women during preconception period, who were selected using the multistage sampling method in 2018. The data collection tool was a researcher-made questionnaire containing sociodemographic information, the BASNEF model constructs, and a short form of the international physical activity questionnaire. Data were analyzed using logistic and linear regression and t-test through the SPSS software version 16.
Results: The results showed that 61.3% of women had low levels of physical activity. Knowledge (β=0.2, P<0.003), attitude (β=0.15, P<0.017), and enabling factors (β=0.18, P<0.004) significantly explained their intention to do physical activity. Also, among the predictive variables, knowledge (P<0.001) significantly explained physical activity.
Conclusion: Low rate of women's physical activity during preconception period calls for designing an intervention based on BASNEF model in order to influence knowledge, attitude and enabling factors.
 

---

Background & Aim: Pain and inflammation caused by needle insertion into the fistula is a common problem in hemodialysis patients. The aim of this study was to evaluate the effect of topical application of Rosemary essential oil on inflammation and pain severity caused by needle insertion into arteriovenous fistula in patients undergoing chronic hemodialysis.
Methods & Materials: In this clinical trial, 60 hemodialysis patients from the hemodialysis ward of Golestan hospital and Imam Khomeini hospital in Ahvaz were randomly assigned to two groups using block randomization. The intervention group received rosemary essential oil, while the control group received distilled water applied to the needle insertion site 5 minutes before each hemodialysis session. Pain severity was assessed using the VAS scale and inflammation severity was determined using the Phlebitis checklist at baseline and during six sessions. Data were analyzed using t-test, chi-square test and repeated measures analysis of variance (ANOVA) on SPSS software version 22.
Results: The results showed that the mean score for pain increased in the control group from 5.13±1.74  to 5.93±1.67, while it decreased in the intervention group from 5.83±1.53 to 3.77±1.43 (P=0.003). Additionally, the mean score for inflammation increased during the sessions in the control group, ranging from 1.27±1.20 to 2.07±1.08. However, in the intervention group, the mean score for inflammation decreased from 2.57±1.92 to 1.33±1.44. Nevertheless, this difference was found to be statistically insignificant (P=0.267).
Conclusion: The findings of the present study showed that the topical application of rosemary essential oil had a significant effect on reducing pain resulting from needling. However, its effect on reducing the severity of arteriovenous fistula inflammation in patients undergoing hemodialysis was not statistically significant. Based on these results, it is recommended to provide training to nursing staff and hemodialysis patients regarding the use of rosemary essential oil as a means to alleviate pain experienced during the procedure. Further research is required to investigate its potential for reducing the severity of fistula inflammation.
Clinical trial registry: IRCT2019102804526N1

 

---

Background & Aim: Patients with heart failure often experience inadequate self-care and diminished quality of life, leading to significant constraints in their daily personal and social activities. This study aims to evaluate the effect of individually designed energy conservation training on enhancing self-care capabilities and improving the quality of life for patients with heart failure.
Methods & Materials: This randomized clinical trial was conducted from June 2022 to May 2023 and involved 60 heart failure patients in the CCU and cardiology ward, as well as cardiovascular clinic at Shahid Madani and Shohadai Ashayer Hospital in Khorramabad, Lorestan. Based on established inclusion criteria, participants were randomly assigned to either the intervention group (n=30) or the control group (n=30). The intervention group received individually designed training in four sessions, each lasting 30 minutes, spaced over three weeks (total duration of nine weeks). In contrast, the control group received standard nursing education upon discharge. Participants completed the European Heart Failure Self-Care Behavior Scale and the Minnesota Living with Heart Failure Questionnaire both prior to the intervention and at the tenth week post-intervention. Data were analyzed using SPSS software version 24, employing the Mann-Whitney U test, Wilcoxon test, independent t-test, and chi-square tests.
Results: After the intervention, the intervention group demonstrated a statistically significant decrease in mean scores for self-care and quality of life compared to the control group (P<0.001). These findings indicate an enhancement in self-care practices and an improvement in the quality of life.
Conclusion: Individually designed energy conservation training effectively improves self-care and quality of life in patients with heart failure. Therefore, using this complication-free, non-pharmacological approach can be beneficial for this patient population.
Clinical trial registry: IRCT20220612055150N1