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: 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 .