---

One of man's fundamental needs is communication. Nurses within their specialty sense this need in their relationship with their patients, even though in some cases with physical impediments e.g. the placing of bypass tubes, this relationship is endangered. This study is a quasi experimental research, whose main aim is to compare the effects of two types of communication methods on anxiety and satisfaction in patients after cardiac and bypass surgery having intubation, warded at chosen hospitals affiliated to the Tehran University of Medical Sciences. According to the specific criteria, 90 patients were randomly selected by divided into two groups (experimental and control). The researchers met all patients the day before the surgery explained the reason and use of the picture chart for the experimental group and the routine communication methods for the control group. Therefore on the day of surgery communication was established with both groups with their own particular method. Data collection was done through a questionnaire consisting of: 1) demographic specification and clinical history, 2) Spielburger's questionnaire for obvious anxiety and 3) visual analogue scale (10cm) for patient satisfaction evaluation which is undertaken the day after surgery and after extubation. The results of the χ² test and the Fisher's exact test showed significant statistical differences between the two groups concerning the level of the patient's anxiety and satisfaction. The use of the picture chart for the experimental group, decreased patient's anxiety resulting from speech disability and increased their satisfaction with their communication with nurses as compared to the control group. Considering the beneficial results from using picture charts in establishing communication with patients, nurses with the help of devices, must try to create better relationships with intubated patients in the post-surgery period and provide them with more desirable services.

---

Post-surgery pain is usually controlled by PRN drugs administered by nurses. According to the decision-making theories, this clinical decision-making depends on three factors: nurse-related factors child-related factors and hospital-related factors. This study deals with the first and second factors mentioned. This descriptive-analytic study aims at determining the perspective of nurses on factors which affect their decisions to administer the analgesic PRN to children after surgery in several chosen hospitals of Tehran. The study used a standardized questionnaire to collect data from 57 nurses in pediatric surgery wards. The questionnaire consisted of three parts: 1) nurses demographic data 2) 20 clinical scenario for nurses to make a decision for prescribing either analgesic medication, non-analgesic medication or no medication where necessary and 3) 12 factors which affect clinical decision-making in using analgesics.(in prioritizing among the above mentioned). The results show that factors such as age, nursing experience, pediatric nursing experience and motherhood were significantly related to choosing to use analgesics. Education and personal experience of extreme pain was also related to the type of analgesic chosen. Concerning the specifics of the children there was a significant difference between the choice to use analgesics and the type of analgesic used according to the various ages of the children. There was also a significant relationship between the type of surgery and the time of surgery and with the choice to use analgesics and the type of analgesics used, such that medication and analgesics were administered more frequently for complicated surgeries and in first 24 hours after surgery. Type of surgery, severity of pain, time of surgery and uneasy behaviors were selected respectively as the most effective in the administration of PRN analgesic drugs. Nurse and child related factors strongly influence nurses in making decisions to administer PRN analgesics postoperatively.

---

Fear is an undesirable feeling which most of the time results in physiological changes and can affect on the cardiovascular function of the patient. This research is a cross-sectional descriptive study that describes the congruency opinions between 91 patients /nurses about the reasons for patients’ fear related to coronary angiography in two affiliated hospitals of Tehran University of Medical Sciences. The tools which were used included: questionnaire for study and recognition of patient and nurses demographic characteristics, a check list containing thirty probable reasons for patients’ fear which were filled out by patients and nurses, and a scale for analysis of the reasons for fear which were filled out by patients, descriptive statistics indicators, sign test, and t-test were applied in order to analyze the data, by SPSS software. The results showed that patients’ and nurses’ ideas about the reasons for fear before angiography are similar in two cases and only in one case after the operation. Among the thirty probable reasons which were mentioned for patients’ fear, seventeen cases caused less fear after angiography and two cases caused more fear after that. In the comparison between the intensity of fear caused by other reasons no insignificant result was observed. The comparison of intensity of fear showed that the intensity of patients’ fear after angiography is less than before (p= 0.005). According to these cases it may be concluded that because of the different reasons for patients’ fear concerning angiography, nurses need to pay more attention to patients’ fear. It is also suggested that an assessment tool be used in order to assess issues relating to patients, level of care and training related to coronary angiography.

---

This research is a descriptive-analytical study conducted with the aim of examining and comparing adjusted behaviors of children (brothers and sisters) suffering from a chronic disease, referred to treatment centers with the siblings of the healthy children of the same age, in Tehran. The research sample was a group of 300 children along with a pair of parents. They were divided into groups of 150 siblings suffering from a chronic disease and 150 siblings who were healthy. For sample-taking of the children suffering from chronic disease parents of the children referring to hospitals or hospitalized in wards, who had the required qualifications were also studied through simple random selection. In order to select healthy children and their parents, the parents of the children referring to specified treatment centers for receiving medication and clinical treatment were selected as the control group, through the simple random sampling method. The basis of research comprised of a questionnaire comprising of two parts. The 1st part consisted of demographic particulars and the 2nd part constituted the form of questions put to the child's parents, whose form was prepared on the basis of the standardized child behavior checklist in accordance with Achen Bach's parents’ report. The form consisted of two parts: one concerning social merit (6 questions on activities, social relations and studying performance of the child) while the other related to behavioral problems of the child (102 questions in relation to social problems, anti-social behavior, aggressive behavior, difficulty in concentration, physical complaints, anxiety, depression, isolation disorder in thinking, sexual problems and miscellaneous matters). The results in relation to the research objectives point out that there is by p<0.001 and p< 0.005 and in a sensible manner, the behavioral problems of the siblings suffering from a chronic disease as compared with healthy siblings are more and their social merit is less.

---

Introduction: In hypertensive patients M position (sitting, right arm at the level of heart and both plantar surface of foots on the floor) is the standard position for measurment of blood pressure since it reveals the “true” pressure. Materials and

Methods: It is a quaziexperimental study that compares effect of different positions of limbs on blood pressure of hypertensive patients. The sample size was consisted of 100 hypertensive patients. A questionnaire and a check list for systolic and diastolic blood pressure of the patients in different positions were used. One researcher collected all of the data. At first demographic data, weight and hight were recorded. After 5 minutes in sitting position in 3 different comparing positions, M (sitting, right arm at the level of heart and both plantar surface of foots on the floor), A (sitting, right arm hanging beside the body and both plantar surface of foots on the floor) and B (sitting, right arm hanging beside the body and right foot on the left knee), blood pressure was measured and recorded. The study methods included interview and physiologic measurement. The paired t-test for related measure was applied in order to analyse the data.

Results: The results showed that the difference of mean systolic and diastolic blood pressure in “A & M”, “B & M” and “B & A” positions was significant (paired t test, p<0.0001) and the mean of systolic and diastolic blood pressure in “A” position was more than “M” position, “B” position was more than “M” position and “B” position was more than “A” position.

Conclusion: According to the findings of this study, “B” position has the greatest effect and “M” position has the lowest effect on increasing the systolic and diastolic blood pressure. This research indicated that attention to the limbs position during the measurement of blood pressure is very important.

---

Introduction: To reduce the morbidity and mortality of cardiovascular diseases, patients are emphasized on following the exact prescription order of their antihypertensive and other cardio vascular medications.

Materials and Methods: The purpose of this study was to identify factors related to medication compliance in patients with coronary heart disease. A descriptive analytical study was designed and a total of 150 patients with coronary heart disease were chosen with convenience sampling among patients in one of the cardiovascular clinics affiliated to Tehran University of Medical Sciences. The instrument included a questionnaire for the demographic data, side effects of the drugs, physical condition, level of cognition and self-reporting of the patients about medication non-compliance A questionnaire which was about attitude evaluation A data evaluation form to calculate the rate of medication compliance Biophysiologic measurments and finally, available documents. The data were collected in two consecutive steps: at the first appointment, the questionnaires were filled. At the second appointment (1 month later) medication compliance rates which was based on counting of pills, were calculated.

Results: The data were analyzed with descriptive statistics, chi-square test, Fisher’ exact test and Tchoprof coefficient. Only 28% of the patients had met the drug regimens appropriately but 56% of them had a poor record. There was a meaningful relationship between the self – reporting of the patients and counting of the pills (p value<0.005). In addition, some factors such as age, education, occupation, teaching and its sources, duration of acquiring the cardiac disease, number of hospitalization and level of cognition of patients under investigation were assessed as effective elements to use the pills properly.

Conclusion: No meaningful relationship was found between sex, marital status, parenthood status, living arrangement, health insurance situation, health personnel availability, positive family history of cardiac disease, co-existence of another disease, difficulty in providing of the drugs, side effects of the drugs, physical condition and attitude and medication compliance. In conclusion, by providing some educational programs about drug regimens, based on the level of cognition, experiences, capabilities, and also the living style of the patients, medication compliance can be improved.