---

This is a double - blind clinical trial to evaluate the safety and efficacy of topical nitroglycerin ointment on venous catheterization in patients referred to emergency ward of Baghiyatollah hospital in 1997.The units under investigation consisting of 70 patients, 40 women and 30 men ranging in age from 20 to 69.The samples were randomly assigned into two equal groups, 35 patients in case group and 35 patients in experimental group. The experimental group received 2% nitroglycerin ointment and the case group received the placebo ointment that was applied prior to venus catheterization on the skin of the dorsum of the hand, wrist or front part of forearm.To collect data, an observational checklist was used in which demographic characteristics, and efficacy and immunity of the ointment were recorded.The findings revealed that the vein diameter in case group was not increased after applying the ointment, while it was considerably increased in experimental group from 4 mm to 6.6 mm. Although the method of catheterization in two groups was the same, catheterization in case group was more difficult than experimental group. Using T.test, the findings revealed that there was statistically significant relationship between vein diameter before and after applying the ointment in experimental group and after applying it in case and experimental groups (PO.001). Moreover, tachycardia and hypotension was not observed in both groups during 15, 30, 45 minutes and one and two hours immediately after applying the ointment, however in both groups, a sort of mild headache was observed. The findings also showed that there was significant relationship in observing the vein after catheterization in two groups (P<0.2). However, before applying the ointment, there was significant relationship in observing the vein in the experimental group. Furthermore, after applying the ointment, arhythmia appeared, but it was not significant.The results showed that applying nitroglycerin ointment was a useful method in expanding the peripheral veins, therefore, it resulted in easy venous catheterization.

---

This study is a quasi-experimental research with aim of evaluation the effect of respiratory exercise in acute respiratory complication and the length of time patient hospitalization undergoing coronary artery bypass surgery in Kermanshah Emam Ali hospital in year 2000 The study subject consisted of 60 patients (42 male and 18 Femal), with age rang between 30-70 years old, who were eligible for this study. The subjects were selected with convenience sampeling and randomly allocated to two groups (Experimental and control). Experimental group received education in two sessions of videoteaching and control group recived routin cares. Tools of data collection consist of demographic questionnaire, clinical records, check list and respiratory exercise. Results revealed: The incidence rate of atelectasis in experimental group was (26.7%), less than contral group (%56.7), test showed significant difference between incidence rate of atelectasis (P = 0.01). Therefore the length of hospitalization in experimental group was less than control group (P=0.02). Accomplishment of post operative respiratory exercises in all samples were lower than doing exercise pre-operatively, and the highest score for effective exercise and coughing were in two and three days after surgery (P=0.000). The result of this research reveales, videoteaching is effective in promoting nursing care and self care in clients.

---

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: Massage of the limbs is a safe procedure that could have therapeutic effects and cause physical and psychological relaxation of patients in intensive care unit (ICU).

Materials and Methods: This survey is a quaziexperimental study that assessas immediate effects of foot massage on patient’s vital signs in a general ICU. After a pilot study, a sample size of 50 patients was chosen. A questionnaire about demographic data and a 3-table checklist for recording vital signs (heart rate, peripheral O2 saturation and mean arterial pressure) was used. The data gathered by interview and physiologic measurement. For every patient, vital signs were recorded every 1 minute interval for 5 minutes (after completing the demographic data). Then foot massage was applied for five minutes and during the massage patients’ vital signs recorded every minute. Immediately the patients’ vital sings were recorded every minute for five minutes. The mean of each parameter was calculated and compared the values at baseline, during massage, and after massage.

Results: The findings showed that there was a significant difference between mean heart rate, mean arterial pressure and mean spO2 before and during foot massage (p<0.0001). Difference between mean heart rate, mean spO2 and mean arterial pressure during and after foot massage was not significant but, deference of mean heart rate and mean arterial pressure before and after massage was significant (p< 0.0001). Difference of mean spO2 before and after massage was also significant (p<0.003).

Conclusion: According to the findings of this study, foot massage has a potential beneficial effect on patients vital signs and last at least for 5 minutes. This effect could be due to increasing relaxation which moderates the changes of vital signs, caused by stress.

---

Introduction: Bed sore is an important complication of operation. Long immobility, hypotension and hypothermia in perioperative period predispose patients to bed sore. The prevention of bed sore is a priority in caring for immobilized patients and different methods have been used for this purpose. Hydrocolloid dressing is one of these methods.

Materials and Methods: This study is a quasi-experimental research. Subjects consisted of 60 patients aged 40-70 years who had eligibility criteria for this study. Subjects were selected with convenience sampling and randomly allocated to two 30-patient groups (experimental and control). In experimental group, hydrocolloid dressing was used before surgery. No procedure was performed for control group. After surgery sacral area was examined on three occasions to detect bed sore: immediately, 24 and 48 hours after surgery. The data were collected by demographic questionnaire and staging bed sore checklist and analyzed by SPSS statistic program and use of descriptive methods such as Chi square, Fisher exact test, t test, ANOVA and least significant difference (LSD).

Results: Incidence of bed sore was 13.3% in experimental group and %36.7 in control group. Chi square test showed significant difference between incidence of bed sore in two groups (p=0.03). Incidence of bed sore in two groups had no relationship with respect to gender and number of grafts. There was a significant relationship between bed sore and age, body mass index and duration of hypothermia, immobility and cardiopulmonary bypass (p<0.05).

Conclusion: Considering findings of this research, it seems that use of hydrocolloid dressing is effective in preventing perioperative bed sore after coronary artery bypass surgery.

---

Introduction: Midwifery practice is involved with clinical judgments which have direct effect on mother&aposs and embryo&aposs health. A midwife should be able to make vital decisions based on her knowledge and skills in emergency situations. A midwife can reach correct decisions by using critical thinking.

Materials and Methods: In this cross-sectional, descriptive-comparative study we compared critical thinking of the first and last trimester baccalaureate and post graduate midwifery students of Medical Sciences Universities of Tehran. A total of 259 qualified students of 2002-2003 educational year were selected by census method. After description the goals and methods of study, we applied California critical thinking skills test (form B) in order to measure level of student&aposs critical thinking. This test is a valid tool for measuring critical thinking and skills, including analysis, inference, deductive reasoning, inductive reasoning and evaluation. Scores were analyzed by statistical tests (ANOVA, t test and Pearson correlation coefficient).

Results: No significant difference between total critical thinking scores of first and last trimester students was found but the scores of critical thinking of the last trimester students showed a significant decrease in Tehran University (p=0.009) and a significant increase in Iran University (p=0.007). No significant difference was found in skills of critical thinking among students. In last trimester students, scores of inductive reasoning showed a significant decrease in Tehran University (p=0.001) and a significant increase in Iran University. There was a significant decrease in evaluation ability scores in Tehran and Azad (open) Universities (p=0.002) a significant increase in these scores was found at Iran University (p=0.008).

Conclusion: According to the results of this study, despite importance of critical thinking, enough attention is not being paid to it during the educational course. The current midwifery education strategies are unable to increase level of critical thinking in students. It is essential to utilize new teaching strategies and active learning methods.

---

Introduction: Gathering information about quality of life is an essential step in designing more effective treatments and also helps developing better supportive and rehabilitation programs.

Materials and Methods: In this cross-sectional to investigate the relation between cancer characteristics and quality of life in patients under chemotherapy, 200 patients with different types of cancers were selected by simple sampling method. The data were collected through interview, reviewing patients’ files and patients’ self-reports. The data were collected by a questionnaire consisted of three parts: part one, demographic characteristics part two, questions about cancer type, stage and duration, pain, acceptance or refusal of cancer by patient, decrease or loss of organs’ function and degree of fatigue, and part three, designed to investigate different aspects of quality of life, including questions about general appearance, physical activity, occupational status, social function and sleep. Descriptive and analytic statistics were used.

Results: The results showed that quality of life in majority of the subjects (66%) was moderate. There was a meaningful relationship between some of cancer characteristics like type of cancer (p=0.007), intensity of pain (p=0.007), decrease or loss of organs’ function (p=0.001) and degree of fatigue (p=0.0) with quality of life, but there was no meaningful correlation between acceptance or refusal of disease, duration of disease from diagnosis time and stage of cancer with quality of life.

Conclusion: It seems that there is a relationship between some cancer characteristics and quality of life. Attention must be paid to these aspects to improve quality of life in cancer patients.

---

Background & Aim: Cigarette smoking is the primary risk factor for COPD (chronic obstructive pulmonary diseases). Smoking cessation is the most effective strategy for prevention or treatment of COPD. Counseling is a efficacious method for smoking cessation. One of the nurses’ roles is counseling that they can use it in patients’ care. The aim of this study is evaluating the effects of counseling in smoking cessation on patient with COPD.

Methods & Materials: This study is an interventional clinical trial and the subjects consisted of 160 patients who had eligibility criteria for this study. Sampling was convenience sampling and subjects were allocated to two patients groups (Interventional and control). In interventional group smoking cessation counseling was used during 12 weeks. Counseling consisted of individual counseling Telephone counseling and self- help material. The data were collected by the questionnaire and Fagrostrom test before study and smoking rate were recorded before, 1 and 3 months after study. Research data were analyzed with spss statistic program and use of descriptive and inferential methods, such as 2, exact fisher test, mann-whitney and etc.      

Results: The rate of smoking cessation after 1 month in interventional group was 28.8% (n=23) versus in control group was 22.5% (n=18) (p<0.0001) and after 3 month in interventional group was 41.3% (n=33) versus in control group was 26.3% (n=21) (p=0.006). Mann-whitney test showed significant difference between smoking cessation in two groups after 1 and 3 month after study.

Conclusion: Results supported the use of smoking cessation counseling to stop smoking on patients with COPD.

---

Background & Aim: One of the responsibilities of nurses is to identify of effective factors on sleeping, because identification of these factors prevents from occurrence of sleep disorders, improves sleeping, decreases duration of hospitalization, and reduces use of hypnotic drugs.

Methods & Materials: This research is a comparative descriptive study. The population under research was included 50 nurses who were working in CCU wards and 50 patients who were hospitalized in CCU wards that were selected by interviewing and information gathering tools was a questionnaires which consisted of tow parts and for each group one questionnaire was used. The first part was included demographic specification. Second part is consisted of 56 questions (four rating) related to effective factors on patient&aposs sleeping in the domains such as environmental factors, personal (physical and mental) factors, pre-sleeping habits and an extra question (to explain other factors with the except of factors that mentioned in sleeping). Gathered data is processed by SPSS software, 12&aposTh version, and for achieving to research goals, descriptive and perceptive statistical methods (such as t-test, ANOVA test, and Pearson coefficient of correlation) were used. Then descriptive statistic was used in data analysis and statistical t-tests were used to compare of these two groups opinions.

Results: The results of this research showed that environmental factors such as turned on light, pain, anxiety due to loss of job, fears of outcome of disease, connection to monitoring systems are the important effective factors on sleeping according to the nurses points of view however patients believe that phone ring, pain, anxiety from loss of job, fears of outcomes of disease, connection to monitoring systems are important.

Conclusion: According to the research results, the most important effective factors on sleeping are "turned on light", "phone ring" "pain", "anxiety from loss of job", "fears of outcome of illness", "connection to monitoring systems". The foundation of this schedule is based on identification of effective factors on sleeping according to viewpoint of patients and then eliminating the disturbing factors.

---

Background & Aim: Fatigue is a premature symptom in the patients suffering from chronic obstructive pulmonary disease. This study was conducted to investigate the effect of breathing exercises on fatigue level of COPD patients.

Methods & Materials: This clinical trial is a semi-experimental study. 60 patients suffering COPD which are bedridden at, Tehran university of Medical Sciences hospital wards which have been sampled simply and divided into experience and control group randomly. Data gathering is done by interview and data registration from the files. The data gathering tools are questionnaires, fatigue severity scale (FSS) and respiratory exercise usage checklist. The questionnaire includes to sections of demographic characteristics and patient info. The exercises check list is scaled from 0 to 40 in the way that the maximum amount of usage in 10 days, for 4 daily sessions would be 40 and for the case of usage 0 score is assigned. Fatigue severity scale includes 9 questions with visual diagrams scaled from 0 (Lack of fatigue) to 4 (server fatigue). The gathered data is analysis using SPSS software and the descriptive and deductive statistical methods (Tisuchi, Kai2 and Pearson correlation exam) are used to achieve the research goals. Results: The results show that the average fatigue intensity for the experience group is 40.916 with the standard deviation of 14.4 and for the control group is 52.20 with 8.539 standard deviation after the study and statistical T-exam (p=0.001) indicated that there is a significant difference in fatigue severity between experience and control groups after the study. The findings also showed that the average fatigue severity before (55.766) and after (40.166) using the respiratory exercises in the experience group (p<.001) has enormous difference. While the average fatigue severity in the control group (p=0.002) before (54.166) and after (52.200) the study has a ting difference. Regarding the correlation of using respiratory exercises and the changes in fatigue severity, the Pearson statistical exam showed that there is a significant reverse correlation between using respiratory exercises and fatigue severity (r=-0.593, p=0.001).

Conclusion: Based on the research findings it can be concluded that using respiratory exercises is effective in reducing the fatigue in the patients with COPD that also confirms the research assumption and the more the respiratory exercises are used the less is the amount of fatigue in the interfered samples.

---

Background & Aim: Pain is one of the important complication of chronic diseases such as cancer. Purpose of this study is to investigation of two non-pharmacological methods, progressive muscle relaxation and music, on pain relief in patients suffer from cancer.

Methods & Materials: This research is a intervention clinical trial which was done in a hospital affiliated to Tehran University of Medical Sciences. In this study, 100 cancerous patients that have inclusion criteria were selected by simple sampling method. The participants into two groups allocated, 50 patients in progressive muscle relaxation, and 50 patients in music group. Data collection tools were questionnaire, pain level recorded sheet, taps with headphone (is produced by Sony company) and music box including light music consist of classical, mild and Iranian traditional music. Questionnaire was designed in two parts, demographically characteristics and disease characteristics. Data were collected by interview and patient self report. After adequate education to two groups, asked them to perform that method 30minet per day until 3 days. Then, pain level, at previous 24 hours until 3 days were assessed and recorded in related sheet. Analysis of data were analyzed by SPSS software, inferential and descriptive statistics such as Mann Whitney, chi Square, Fisher’s exact test, and Friedman.

Results: The finding of research showed in both relaxation and music groups there were significant differences in pain level before and after intervention (p<.001). Also there were significant differences between two groups in pain level (p=0.016). It means that pain relief in relaxation group was more significant.

Conclusion: According to the findings of this research, although both progressive muscle relaxation and music are effective and decreasing of pain level but progressive muscle relaxation is more effective than music.

---

Background & Aim: Item analysis is a process in which both test items (questions) and students&apos answers are examined in order to assess the quality and quantity of the items and test as a whole. The purpose of this study was to investigate the effect of analysis of multiple choice test items of summative exams on quality of the test design by faculty members of Tehran Nursing and Midwifery School.

Methods & Materials: A quasi experimental method (pre-test and post-test) without control group was used in this study. After a pilot study, 33 nursing faculty members of school of nursing and midwifery at Tehran University of Medical Sciences were chosen through census sampling. Then one of their exams designed in the second semester (83-84) were chosen to be analyzed. The analysis results were reported to the faculty members. Then their designed tests for the next semester were analyzed again. The analysis was carried out using a checklist which included item structure, whole structure of exam, content validity, and levels of thinking skills reflected in questions and criteria for holding an exam. Moreover, for the quantitative analysis of questions, item difficulty and discrimination index were calculated. Item distracter analysis was examined by calculating the percentage of examinees who selected incorrect alternatives. Integrated t-test, Pearson and Spearman correlation coefficients, and Fisher&aposs exact test were used for the statistical analysis.

Results: 1056 questions before presenting the feedback and 803 questions at the end were analyzed and then the results were compared. According to the results, there was a significant difference between before and after intervention in variables item structure (P<0.001), levels of thinking skills (P<0.05), and item distracter analysis (P<0.001).While there was not significant difference between item difficulty, discrimination index, whole structure of exam, content validity, and criteria that should be considered on holding of an exam. Although, Pearson correlation coefficient showed that variables such as age (r=-0.535, P=0.004), and years of services (r=-0.546, P=0.003) with difficulty index were statistically significant.

Conclusion: The results emphasized that item analysis, providing feedback to the faculty members and offering educational booklets to assist them were effective means on improving some qualitative and quantitative items analysis measures.

---

Background & Aim: Health is one of the vital concepts in every society which is affected by several factors including age, gender and social situation of the people. Individuals&apos perception of health concept is also of paramount importance. The main objective of this study is to determine health concept perceptions and health promoting behaviors among Tehran University medical and non-medical students

Methods & Materials: This is a descriptive- analytical study. Four hundred medical students and four hundred non-medical students were recruited for the study using stratified sampling. A three-section self-evaluating questionnaire including demographic information, health perception information and health promoting behaviors information was used to gather data. Data were analyzed using descriptive statistics, t-test and Pierson Correlation Coefficient.

Results: 49.7 percent and 6.8 percent of the medical students had good and excellent perceptions about health concept, respectively. In non-medical students, it was 49.4 percent and 8.6 percent, respectively. 57 percent of the medical students and 54.9 percent of non-medical students had good health promoting behaviors, respectively. There was significant relationship between perceptions of health concept and health promotion behaviors among both groups (P<0.001).

Conclusion: Based on the results, there is a direct relationship between perception of health concept and health promoting behaviors among both groups. There is no difference in all aspects of health promoting behaviors, except for cigarette smoking in which the medical students showed more healthy behaviors.

---

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: Anxiety is a common experience which is felt as uneasiness, non-specific threat, and activation of autonomic nervous system. The aim of this study was to assess the effect of muscular relaxation on anxiety level of patients underwent cardiac catheterization.

Methods & Materials: In this clinical trial, 118 patients who were expected to have a cardiac catheterization were recruited from an educational hospital at Tehran University of Medical Science. The participants were allocated to two groups, including muscular relaxation group (50 patients), and control group (68 patients). Data were collected using a questionnaire, and a self-report paper for recording anxiety level. Anxiety level was recorded one hour before cardiac catheterization in two groups. Then, the intervention group was asked to listen to the Benson muscle relaxation guide direction tape for 20 minutes through headphone. After using muscle relaxation in the intervention group and immediately before cardiac catheterization, the anxiety level of the respondents was recorded once more. Control group received standard nursing cares. Data were analyzed using χ², Fisher&aposs exact test, Kruscalwallis, Man-Whitney and Wilcoxon statistical tests in the SPSS.

Results: There were no significant difference between two groups in demographic characteristics and anxiety level before the intervention and one hour before cardiac catheterization. After the intervention, the anxiety level was significantly reduced in the intervention group (P<0.001) while it increased in the control group.

Conclusion: Based on the results of this study, Benson muscle relaxation significantly decreased anxiety level in patients who were expected to go for cardiac catheterization.

 

---

Background & Aim: Diet adherence is a major issue in cardiovascular diseases control. Patient education could be a valuable strategy for promoting diet adherence. The aim of this study was to compare the effects of computer-assisted vs. face to face education on dietary adherence among patients with myocardial infarction.

Methods & Materials: In this experimental study, 117 patients with the first acute myocardial infarction were selected via a convenience sampling. The participants were randomly allocated into three groups. Patients in the face to face group (n=43) received an education about diet in two two-day sessions. The computer-assisted education group (n=33) received the same educational plan provided by computer software containing audio, text, images and animations at home. The control group (n=41) received their usual care. Adherence to dietary regimen was assessed three months after the educations.

Results: There were not significant association between the three groups in terms of demographic characteristics and disease history. There were no significant different in unhealthy diet adherence between the three groups. There were not significant differences in healthy diet between the computer-assisted and face to face education groups. The computer-assisted education group had significantly better adherence with the consumed amount of fats (P=0.01), useful meat substitutes (P=0.01), and other foods (P=0.012) than the control group. In addition, the face to face education group had significantly greater adherence scores with consuming meat substitutes (P=0.04), and fats (P=0.04) than the control group.

Conclusion: Both computer-assisted and face to face educational strategies had positive effects on improving adherence following myocardial infarction.

---

Background & Aim: Premature infants undergo painful and stressful procedures during care and treatment. Nurses can help to reduce short- and long-term effects of pain caused by diagnostic and therapeutic procedures using various methods including music therapy. The aim of this study was to assess the effect of music therapy on physiological pain responses of premature infants during and after blood sampling.

Methods & Materials: This was an experimental study with crossover design conducted on 20 premature infants hospitalized in the intensive care unit of a hospital affiliated to the Tehran University of Medical Sciences for a five months period in 2010-11. Infants were randomly allocated in two groups of experiment and/or control. Each infant was considered as its own control. We assessed the physiological pain responses caused by blood sampling such as heart rate and oxygen saturation level. Infants in the experiment group listened to the Transitions music five minutes before until 10 minutes after the blood sampling. The responses were recorded and reviewed ten minutes before until ten minutes after the blood sampling in both groups and physiological changes were detected. Data were analyzed using ANOVA and Chi-square tests in the SAS and SPSS.

Results: Results showed significant difference in heart rate between the experiment and control groups during needle exit (P=0.022). There was also significant difference in heart rate between experiment and control group in the first 5 minutes of blood sampling (P=0.005).

Conclusion: Results showed that music therapy could reduce some physiological responses of pain during and after blood sampling. Music therapy can be used as a beneficial intervention following painful procedures such as blood sampling in the NICU.