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Background & Aim: Intradialytic hypotension is the most frequent complication in 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 sodium profile and ultra filtration (UF) profile. The aim of this study 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 University underwent three kinds of treatment: (1) control, constant dialysate sodium concentration of 138 mmol/L with constant UF (2) linear sodium profile + UF profile (type1), a linearly decreasing dialysate sodium concentration (146-138mmol/L) in combination with a linearly decreasing UF rate and (3) stepwise sodium profile + UF profile (type2), a stepwise decreasing dialysate sodium concentration (146-138 mmol/L) in combination with a stepwise decreasing UF rate. Each treatment 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.

 

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  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.

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Background & Aim: Hysterectomy is one of the most common surgeries in women, which causes many physical and psychological complications including anxiety. The aim of this study was to compare the effect of diaphragmatic breathing and pursed lip breathing on anxiety in women undergoing hysterectomy.
Methods & Materials: In this double-blind randomized controlled clinical trial, 126 patients referred to Taleghani hospital of Arak during 2017-2019 were selected by convenience sampling, and then assigned into three groups of diaphragmatic breathing, pursed lip breathing and control using the random number table. Anxiety was measured the evening before the operation (before the intervention), one hour before entering the operating room (after the intervention) and two hours after the operation, using the Spielberger Anxiety Questionnaire. Data were analyzed using descriptive and analytic statistics using the SPSS software version 16.
Results: The mean and standard deviation of anxiety scores for the diaphragmatic breathing, pursed lip breathing, and control groups were 55.33±10.49, 55.4±9.84, and 55.07±11.31 respectively, and there was no significant difference between the groups (P=0.983). One hour before going to the operating room (after the intervention), the mean and standard deviation of the anxiety score was 41.98±8.5, 42.43±7.88, and 52.86±11.5, respectively, and after the operation, the scores decreased to 37.79±8.13, 38.07±8.33 and 50.62±11.35 respectively. There was a significant difference between the three groups (P<0.0001). There was no statistically significant difference in the anxiety scores between the diaphragmatic breathing group and the pursed-lip breathing group after the intervention (P=0.999).
Conclusion: The results of this study showed the diaphragmatic breathing and pursed-lip breathing techniques are effective in reducing hysterectomy anxiety in women. Therefore, using this non-pharmacological approach is recommended to reduce anxiety before and after hysterectomy surgery.
Clinical trial registry: IRCT20180103038211N4
 

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Background & Aim: Clinical decision-making is an essential part of the nursing profession. The nursing profession is based on ethical principles. Due to their commitment to patients, morally courageous nurses ignore occupational risks threatening their own lives.  The aim of this study was to investigate the relationship between moral courage of nurses and their participation in clinical decision-making.
Methods & Materials: This descriptive, cross-sectional study was conducted in 2019. The study population was nurses working in the CCU and ICU of Shahid Rajaie Cardiovascular Medical and Research Center. The sample size was 195 people. The data was collected using the Sekerka’s Moral Courage Scale, and the Participation in Decision Activities Questionnaire (PDAQ). Data was analyzed using descriptive statistics, independent t-test and Pearson correlation coefficient through the SPSS software version 19.
Results: The mean scores of moral courage and PDAQ in nurses were 90.38 ± 11.48 and 117.24±39.42, respectively. A positive correlation was found between moral courage and participation in clinical decision-makings (r=0.397, P<0.001).
Conclusion: The results showed that moral courage has pride of place in the nursing profession that can encourage nurses to actively participate in clinical decision making. Therefore, professional ethics courses are suggested to be organized to improve decision-making and clinical ethical performance of nursing students and nurses.
 

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Background & Aim: Parents of children with autism face numerous challenges that hinder their social adjustment. Spiritual health emerges as a relevant components that can potentially enhance their social adjustment. The present study was conducted with the aim of investigating the relationship between spiritual health and social adjustment among parents of children with autism.
Methods & Materials: This is a descriptive correlational study that investigates a sample of 194 parents of children with autism at Hekmat Autism Center in Borujerd and Yekta Autism Center in Khorramabad, during the period of March 2021 to April 2021. To collect data, a demographic information questionnaire, the Paloutzian and Ellison spiritual health questionnaire, and the personal resource questionnaire were employed. Data analysis was conducted using the SPSS software version 26, utilizing the Chi-square test, one-way analysis of variance (ANOVA), and Pearson's correlation coefficient.
Results: There was a statistically significant relationship between the scores of spiritual health (82.03±17.68) and social adjustment (78.52±15.59) among the parents (r=0.572, P=0.0001). The parents with low spiritual health had a mean social adjustment score of 65±0, while those with moderate spiritual health had a mean score of 76.63±15.76, and parents with high spiritual health had a mean score of 89.19±9.45. These results indicate that there was a statistically significant difference in the mean scores of social adjustment across different levels of spiritual health (P<0.001).
Conclusion: There was a significant correlation between spiritual health and social adjustment among parents of children with autism, suggesting that higher levels of spiritual health were associated with increased social adjustment. To enhance the social adjustment of these parents, it is advisable to implement appropriate planning aimed at improving their spiritual health.