---

Background & Aim: Improving the mental health of mothers of children with thalassemia major who experience great caregiving burden, requires an efficient supportive training to be developed and implemented. Therefore, this study aimed to determine the impact of a group supportive training on caregiving burden in the mothers of children with thalassemia major.

Methods & Materials: A quasi-experimental study (IRCT2016122731612N1) was conducted on 80 mothers of children with thalassemia, referred to Aliasghar hospital in Zahedan in summer 2016. The mothers were selected through convenience sampling method and divided into two intervention and control groups of 40 each. The intervention group received four sessions of supportive training during four weeks. Data were collected by the Caregiver Burden Inventory. SPSS version 21 and independent t test, paired t-test and the analysis of covariance were used to analyze the data.

Results: The mean score of caregiving burden before training in the intervention and control groups were respectively, 86.60±13.55 and 92.37±8.54 and declined to 59.62±9.90 and 89.57±5.83 after the intervention. Furthermore, The caregiving burden score in  five dimensions including  temporal,  developmental, physical, social and emotional was significantly lower in the intervention group than in the control group  (P<0.05).

Conclusion: The findings showed that collective supportive training leads to a decrease in caregiving burden in the mothers of children with thalassemia. Thus, this training could be an effective method in reducing the mothers’ caregiving burden. This program could be used in health centers in order to maintain and improve the mental health of mothers.

---

Background & Aim: The role of caffeine as a cerebral stimulant for improving respiratory indicators in the mechanically ventilated patients is unclear. The purpose of this study was to evaluate the effect of coffee consumption on respiratory indicators among the mechanically ventilated patients in the Intensive Care Unit (ICU).
Methods & Materials: A double blind, randomized clinical trial (IRCT2013122915972N1) was performed on 80 patients who were selected by convenience sampling and randomly allocated into two groups (intervention and control). For the intervention group was administered 3.5 grams of espresso coffee powder dissolved in 80 cc water, then 20 cc water through gavage about an hour after breakfast. The control group received 100 cc distilled water. Respiratory parameters were recorded and compared in the two groups 2 minutes before the intervention and 30 minutes and 60 minutes after the intervention. Chi-square test, t-test and the repeated measures analysis of variance were used to analyze the data.
Results: There was no difference between the two groups in the baseline variables. After the intervention, the spontaneous respiratory rate, tidal volume, the minute ventilation rate and arterial O2 saturation increased in the intervention group compared to the control group, but the increase was statistically significant only for the spontaneous respiratory rate and tidal volume.
Conclusion: Espresso coffee consumption through gastric tube in the mechanically ventilated patients increases the spontaneous respiratory rate and tidal volume but does not significantly affect other respiratory indicators.
 

---

Background & Aim: Infant hospitalization in the intensive care unit is stressful for parents so that it affects their parental role. Nurses, due to their special situation, can play an important role in reducing parental stress. This study aimed to determine the effect of parental role training by a nurse on stress in the parents of hospitalized newborns in a neonatal intensive care unit.
Methods & Materials: A quasi-experimental study (IRCT201605131788N17) was conducted on 72 parents (36 couples in the intervention group, 36 couples in the control group) of hospitalized newborns in the neonatal intensive care unit of Ali-Asghar hospital in 2016. The intervention group received the parental role training based on their needs. Their stress level was compared with the control group using the Parental Stress Scale. Data were analyzed by descriptive statistics, chi-square test, paired t-test, independent t-test and Fisher's exact test using the SPSS software v.16.
Results: Before the education, there was no significant difference in the stress level between the two groups (P>0.05). After the education program, the stress level in the intervention group fell on the tenth day compared to the control group (P<0.001).
Conclusion: Training parents based on their educational needs reduces their stress. By reducing stress and improving the role of parents, it can be assured that the newborn is provided with the quality care at the time of admission.
 

---

Background & Aim: Exposure to high stress in the work environment among the intensive care unit nurses results in leaving the profession and their unwillingness to continue their activities. This is one of the major challenges in the nursing profession and has a great effect on the effectiveness of health systems. Despite the importance of resilience, there is few studies on the intensive care unit nurses’ resilience. The aim of this study was to determine resilience and its association with the intensive care unit nurses’ intention to leave their profession.
Methods & Materials: This is a cross-sectional, descriptive analytical study on 400 nurses working in the intensive care units of teaching hospitals affiliated to Tabriz University of Medical Sciences in 2016. Data were collected through a modified form of Anticipated Turnover Scale designed by liou and a summarized form of Connor-Davidson’s resilience scale". Descriptive and inferential statistics (Mann-Whitney, and Kruskal-Wallis) were used for data analysis through SPSS version 13.
Results: The mean rank for intention to leave and resilience was 2.83 (IQR: 0.67) and 25.50 (IQR: 8) respectively. Also, there was a negative, significant correlation between resilience and intention to leave (P<0.001, R=-0.173).
Conclusion: Considering the rate of intention to leave the profession, more attention is needed to the factors affecting the intention to leave. In addition, due to the significant relationship between resilience and intention to leave, incorporating resilience-promoting strategies into nursing curriculum is recommended.
 

---

Background & Aim: Family-centered care is a concept for describing the approach to caring for children and their families in health services and its main element is the involvement of parents in child care. This study aimed to compare the perception of family-centered care from the perspectives of nursing staff and mothers of hospitalized children in children’s wards.
Methods & Materials: This study was a cross-sectional study conducted on 82 mothers of hospitalized children and 60 nurses working in children’s wards of Afzalipour hospital in Kerman in 2017. In this study, a questionnaire on the family-centered care perception from the perspectives of nurses and mothers was used for data collection. Data were analyzed through SPSS software version 20 using t test, analysis of variance and Pearson correlation coefficient.
Results: Average scores for the perception of family-centered care from the perspective of nurses (3.17±0.79) and of the mothers (2.47±0.85) had significant differences between the two groups (P<0.001). In two groups, the highest average was related to the area of cooperation and the lowest average was related to the support area.
Conclusion: Findings showed nurses’ and mothers’ perceptions of family-centered care were positive but nurses have significantly more positive perception than mothers. This can be promising and nursing staff are required to be diligent about mothers’ participation in care so that the child receives better care.
 

---

Background & Aim: The most common complication of peripheral intravenous catheter use is phlebitis. This study aimed to determine the effect of Arnebia Euchroma on the prevention of peripheral intravenous catheter-related phlebitis.
Methods & Materials: A double-blind randomized clinical trial done on 120 patients hospitalized in CCU and heart wards of Shariaty hospital in Tehran in 2017. The convenience samples were allocated into the two groups of control and intervention. After the insertion of an IV catheter (by sterile technique, in the site of upper limb without any signs of phlebitis), Arnebia Euchroma poultice for the intervention group and placebo poultice for the control group, was applied to the skin in the distal portion of IV catheter at 3×3 cm from the catheter insertion site. Then, this site was covered by sterile dressing. The patient was monitored every 12 hours by removing the dressing, and the poultice was applied again. Data were analyzed by descriptive and inferential statistics using the SPSS software.
Results: The two groups were homogeneous in terms of age and sex, but were different in the number of hospitalization days. While no phlebitis was observed in the baseline, there was a significant difference between the two groups (42.37% for intervention group vs 0% for control group) at the hour of 12. By adjusting the effect of hospitalization days, the difference was still significant (P<0.001).
Conclusion: Arnebia Euchroma poultice was effective in the prevention of phlebitis. Thus, this poultice can be used when inserting a peripheral intravenous catheter.
Clinical trial registry: IRCT2017012432147N1
 

---

Background & Aim: Anxiety is one of the most common psychiatric disorders in the family of patients with traumatic brain injury. This study aimed to determine the effect of providing information about the patient’s condition on the anxiety level of the family members of hospitalized patients with traumatic brain injury.
Methods & Materials: This quasi-experimental study was conducted on 90 family members of traumatic brain injury patients admitted to Shahid Bahonar hospital in Kerman in 2016. The participants were selected by the consecutive sampling method and were assigned to intervention and control groups. In the intervention, the participants were informed by the nurse about changes in the patient’s condition during the first three days of admission to intensive care unit. During this period, the control received routine care. Data collection tool was the Spielberger anxiety inventory. Independent and paired t-test were used to compare the mean scores of anxiety using the SPSS software version 16.
Results: There was no statistically significant difference in the mean scores of overt, covert and general anxiety between the two groups before the intervention (P>0.05). However, after the intervention in the experimental group, the mean scores of overt anxiety (45.51±7.26), covert anxiety (45.42±6.51) and general anxiety (90.93±12.72) decreased (P<0.05) compared to the mean scores of overt anxiety (49.22±9.42), covert anxiety (49.02±9.15) and general anxiety (98.24±17.67) in the control group.
Conclusion: Providing planned information on changes in the condition of hospitalized patients with traumatic brain injury can reduce the anxiety of family members of these patients.
Clinical trial registry: IRCT20180206038642N2
 

---

The World Health Organization (WHO) has introduced palliative care as a way to improve the quality of life of patients with incurable diseases and their families. This care begins with the diagnosis of the disease, and continues throughout the illness (1). Palliative care improves the quality of life of patients with life-threatening diseases and their families. Its purpose is to relieve suffering through the identification, evaluation, and relief of pain and other physical, psychosocial and spiritual problems (2).
Palliative care is required for many diseases. According to reports, every year about 40 million people in the world need palliative care, but only 14% of them receive it, of whom 78% live in low-income or middle-income countries. According to the World Health Organization, patients who require palliative care services, suffer from cardiovascular diseases (38.5%), cancer (34%), chronic pulmonary diseases (10.3%), AIDS (5.7%), and diabetes (4.6%). Other patients with diseases, such as dementia, kidney failure, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, neurological diseases, congenital anomalies, and resistant tuberculosis may also need palliative care services (1). Palliative care can be offered to patients through various models, including hospital-based palliative care, hospice-based palliative care and home-based palliative care (3). Studies have shown that home-based palliative care has a very beneficial effect on the physical, mental, psychological, social and economic dimensions of patient’s life, and reduces the cost of health system, shortens the length of hospitalization, reduces hospital complications and prevents hospital readmission (4-6). This type of care also facilitates the continuity of post-discharge care and helps patient to easily benefit from the facilities of different centers (7). On the other hand, most people prefer to receive care at their homes with their families (8). Studies have shown that home-based palliative care is clinically and economically effective and leads to the satisfaction of patients and their families. Also, the World Health Organization in 2014 has introduced home-based palliative care as one of the main elements of the health systems all around the world (1). However, reports indicate that many countries in the world do not have palliative care programs in their health care system (7), and the lack of government support for palliative care services, lack of prepared professional staff to provide palliative services, limitation in access to narcotic analgesics, resource constraints, lack of policy-makers’ familiarity with palliative medicine, the negative attitude of society towards palliative care and socio-cultural issues have been mentioned as barriers to palliative care in the world (1, 9,10).
Iran’s health system is faced with increasing number of chronic patients and shortages of manpower and ICU beds in health centers. Most patients with life-threatening diseases in Iran are frequently admitted to hospital during the last days of their lives. Despite the shortage of hospital beds, especially in the critical care units, these patients occupy these beds and receive specialized medications until the end of their lives and eventually many of these patients die on ICU beds in hospital (11). While in many cases, hospitalization of incurable patients in critical care units does not have any positive effects on patients’ recovery, and is considered a futile care (12), which increases the costs of health system, poses financial burden on patient’s family, and leads to dissatisfaction and work burnout in healthcare staff (13). On the other hand, many of these patients prefer to spend the last days of their lives at home with their family and be in close contact with their relatives. Evidence suggests that palliative care in Iran is only offered in isolated and limited centers. Most patients are deprived of this kind of care, and home-based palliative care does not have any place in Iran’s health system (14). Patients with incurable conditions who require palliative care services are lost in the system, and in most cases do not receive proper and timely services they need (15). Also, the traditional attitude of healthcare staff towards the management of incurable conditions, the lack of transparency in the protection of healthcare staff against discontinuation of unnecessary treatments or unreasonable expectations of patients and their families, as well as social and cultural differences are barriers to the promotion of palliative care in Iranian society. Another problem in providing home-based palliative care services is the defect in the payment process and insurance coverage of end-of-life patients (16,17). Therefore, given the high prevalence of chronic and incurable illnesses, the increasing number of elderly population, limited critical care beds, shortages of human resources, limited financial resources and equipment in health centers, and taking into account the benefits of home-based palliative care, healthcare system authorities should consider this care method to be one of the important priorities of the health system so that patients can maintain their quality of life and also experience peace during the last days of their lives. Considering the limited research in this field, further research is required on the management of various dimensions of home-based palliative care in order to provide suitable models for the provision of home-based palliative care services in Iran.
 

---

Background & Aim: Insufficient health literacy is a major barrier to self-care in patients with heart failure. The purpose of this study was to determine relationship between health literacy and self-care behaviors in patients with heart failure.
Methods & Materials: In this correlational study, 100 patients with heart failure who were referred to teaching hospitals in Qom were selected through the convenience sampling method in 2017. The data collection tools were the heart failure-specific health literacy scale, the self-care of heart failure index (SCHFI) and the hospital anxiety and depression scale (HADS). Data were analyzed using descriptive statistics, the Pearson’s correlation coefficient and multiple liner regression analysis on the SPSS software version 16.
Results: More than half of the patients had a moderate level of self-care. The highest and lowest health literacy scores were respectively related to critical health literacy (10.47±2.56) and functional health literacy (9.14±3.74). The result of multiple regression analysis showed that only functional health literacy was a better predictor of self-care behaviors in patients with heart failure (β=0.30, P=0.014).
Conclusion: The findings showed that functional health literacy was an important predictor of self-care behaviors among patients with heart failure. It seems necessary to design effective interventions in order to improve patients’ skills for analyzing functional information and decision making in self-care.
 

---

Background & Aim: Falling is a serious problem in the elderly population, with many physical, psychological, social and economic consequences. The fear of falling has been considered an activity limiting condition, which can lead to a reduction in the quality of life of the elderly people. The study aimed to determine effect of fall care behaviors training on fear of falling among the elderly people referred to health centers.
Methods & Materials: This double-blind randomized clinical trial was carried out on 110 elderly people referred to health centers in Ardabil in 2017. Participants were selected by the multi-stage random sampling and divided into intervention and control groups by random allocation. The data collection tools were consisted of demographic questionnaire, Mini-Mental State Examination: MMSE, Abbreviated Mental Test Score: AMTS and Fall efficacy scale international: FES-I. Data were analyzed using statistical tests on the SPSS software version 22.
Results: The mean and standard deviation of fear of falling in the intervention and control groups before the intervention were 33.91±12.03 and 31.22±14.76, respectively (P=0.29). Three months after the intervention, the mean and standard deviation of fear of falling were 22.32±4.45 and 30.85±15.03 (P<0.001). Also, ANCOVA was used for controlling pre-test scores and level of education compared to the post-test scores in the two groups (P<0.001).
Conclusion: The results showed that education on fall care behaviors reduces the fear of falling in the elderly people. Therefore, this education is suggested to be considered in the self-care program for elderly people.
Clinical trial registry: IRCT20180205038618N1
 

---

Economic evaluation is an invaluable and important tool in healthcare decision- and policy-making. The volume-based paradigm has been a prominent tool to evaluate healthcare economy for consecutive decades. In this approach, the main focus is on volume of treated patients alongside to reduce healthcare costs. Despite this view and during recent years, there was a dramatic rising in healthcare costs without attaining excellence in quality and health outcomes. This status is escalating to the point at which governmental budgets, service providers, and patients are unwilling or unable to afford its related costs (1). There is a similar situation in high-income countries that spend several times more money on health than middle-income and low-income countries (2).
The experts believed that one of the most important and underlying causes of this situation is ineffective healthcare service models that resulted in fragmentation, lack of coordination, reduced quality of care, and finally increased health costs (3). It is assumed that the health service delivery models can seriously affect health costs. Accordingly, health economics does not only refer to health costs but also it includes quality improvement, access to, and equity of health services (4).
For the first time in 2006, “value-based care” was developed to evaluate healthcare economy (5). This paradigm which is also considered a kind of healthcare delivery model, is based on patient outcomes payment as an alternative for the fee-for-service model of payment. Based on this approach, healthcare providers such as physicians and nurses will be rewarded when their services improve the health of patients, reduce the complications, and help to make a healthier life for patients (6); while the population transition to old age and an increase in noncommunicable diseases which require behavioural approches for modifying risk factors in addition to acute care only, are also fueling the mandate for change. Therefore, 30% of healthcare payments in the US by the end of 2016 and 50% of payments by the end of 2018 were tied to the value-based care approach. Based on that, new institutions such as Accountability Care Organizations (ACOs), Advanced Primary Care and Integrated Care models were launched (7). The focus of these institutions is on effective care pathways which, along with the reduction in health care costs, lead to prevention and primary care (7). The principals of new payment model are greater teamwork and integration, more effective coordination of health providers across settings, greater attention to population-based healthcare, and providing information system to improve care for patients (7).
A report in 2011 entitled “The future of nursing: leading change, advancing health” asserted that despite the financial concerns, nursing service can on the one hand address the increasing demand for safer and high-quality healthcare and on the other hand, create equitable and affordable access to health services for societies (8).
The report believed that nursing practice covers a broad continium from health promotion, to disease prevention, to coordination of care, to cure-when possible-and to palliative care-when cure is not possible. Therefore, nurses have a direct and indirect effect on patient care. They can provide assessments and care in hospitals, nursing homes, clinics, schools, ambulatory settings, and workplaces and accordingly they can contribute to the provision of accessible, equitable, and high quality care in healthcare system.
From value-based model perspective, quality, access, and value are key indicators that are specific and sensitive to health service effects on health economics (1). Evidence reveals that nursing services can suprisingly affect these three indicators. However, there are few studies showing that the development of nursing services results in lower costs, along with increased service quality. Of course the evidence in favor of such a conclusion is growing. The current evidence on these indicators are as follows:
Nursing and health service quality
Although causation is difficult to prove, an emerging body of literature has revealed that the quality of care depends, in a large degree, on nurses.  The association between nursing care and quality of hospital care such as patient outcomes, including lenghts of stay, mortality, pressure ulcer, deep vein thrombosis, and hospital-acquired infections has been published in several studies (9-11). Studies have shown the role of nurses in improving the quality and efficacy of hospital (12,13). However, the extent to which nursing care has an impact on health and life or death issues is still ambiguous (8) Also, the patient-centered nursing care has recently been disscussed as a cause of patient satisfaction which is an indicator of the delivered service quality in all over the world (14,15).
Nursing and access to health services
Evidence suggests that access to quality care can greatly be expanded by developing the use of nurses in primary, chronic, and transitional care from hospital to home. For example, If nurses are involved in special roles such as care coordinators or primary healthcare providers, that increase the level of access to services, the hospitalization and rehospitalization rates of patients will be reduced. A 52% reduction in emergency department (ED) visits with a cost per admission of at least $800 has been mentioned as a result of nursing postoperative visits and telephone follow-ups (16). In the coordination of transitional care from hospital, nursing visits during a three-month transition period in patients with heart failure showed the average savings of $4,845 per patient with a significant increase in survival and fewer readmissions (17). Also, performed activities such as self medication management and referral care coordination by nurses in community-based or ambulatory care settings can save $686 per patient in a 12-month period (18).
Nursing and value of health services
The value in healthcare is expressed as the physical health and sense of well-being achieved relative to the cost. There is little evidence at the macro level indicating that the development of nursing services results in cost savings to society while promoting outcomes and ensuring quality (19).  For example, managing nursing work hours is dramatically associated with 1.5 million fewer hospital days, nearly 60,000 fewer inpatient complications, and 0.5 percent reduction in costs (20). 
Overall, it seems that we need to conduct precise studies at macro-level to assess the net economic effects resulting from nursing care delivery models in order to seriously integrate them into health policy. Also, undrestanding the impact of nursing care on the health system requires the data to enable nurses have more effects on healthcare transformation.   
 

---

Background & Aim: Active participation of families can be an influencing factor on delirium in patients hospitalized in the ICU. The present study was conducted to investigate the effect of scheduled visits on delirium intensity in elderly patients hospitalized in the ICU.
Methods & Materials: This clinical trial was conducted on 70 elderly patients hospitalized in the ICU of Ali ibn Abi Talib hospital in Rafsanjan from November 1, 2017 to March 1, 2018. In the intervention group, patients were visited in two out-of-schedule sessions for three days in the morning and night. The control group received routine visits for 3-5 minutes. To assess delirium, the Neecham questionnaire with a scoring scale of 19-30 was used. The data were analyzed using the SPSS software version18.
Results: There was no statistically significant difference between the two groups in terms of age, sex and educational level. Before the intervention and one day after the intervention, no significant difference was observed in delirium score between the two groups. However, on the second day in the intervention group, the median and interquartile range for delirium were 27(3) and in the control group were 25(2) (P<0.0001). On the third day after the intervention, differences between delirium score in the intervention and control groups were 27(3) and 25(3), respectively (P<0.0001).
Conclusion: Scheduled visits can be considered an effective non-pharmacological method for preventing delirium in elderly patients hospitalized in the ICU.
Clinical trial registry: IRCT20150519022320N7
 

---

Background & Aim: Stoma in children causes physiological and psychological changes and reduces self-esteem and quality of life. The aim of study is to determine the effectiveness of self-care skills training on self-esteem and quality of life in 8-12 year old children with stoma.
Methods & Materials: This study is a non-randomized clinical trial with pretest and posttest design, performed in selected hospitals (Mofid, Hazrat Ali Asghar and Medical Center) in Tehran in 2016-17. A total of 36 children aged 12-8 years with stoma, were selected using the convenience sampling method and divided into two groups of intervention (n=18) and control (n=18). Self-care skills training was performed in six sessions of 45 minutes for the intervention group. The control group received routine care. The Cooper Smith questionnaire and the Kindle quality of life questionnaire were used in this study. Data were analyzed by descriptive and inferential statistics using the SPSS software version 16.
Results: The repeated measures analysis of variance showed a significant difference in the quality of life score means over time (P<0.005) and between the two groups of intervention and control (P<0.015). Also, there was a significant difference in the self-esteem score means over time (P=0.004) and between the intervention and control groups (P=0.004).
Conclusion: Self-care skills training for 8-12 year-old children with stoma, has increased their self-esteem and quality of life. Therefore, nurses can use self-care skills training for similar patients.
Clinical trial registry: IRCT20160802029166N2
 

---

Background & Aim: Cancer as one of the most common illnesses in the world is associated with mental, physical, social and financial problems, which affects not only the patients, but also the family caregivers and creates a burden of care. Some studies have shown that spiritual well-being is effective in reducing the burden of care. Therefore, this research was conducted to determine the correlation between spiritual well-being and burden of care in family caregivers of cancer patients.
Methods & Materials: In this cross-sectional correlational study, 150 family caregivers of cancer patients referred to Taleghani, Shohadaye Tajrish, Masih Daneshvari and Imam Hossein hospitals in Tehran were selected by the convenience sampling method from August to November 2017. The data gathering tool was a questionnaire, and data were analyzed using descriptive statistics, Pearson and Spearman correlation coefficients, independent t-test, analysis of variance and multiple regression analysis at a significance level of 0.05.
Results: The mean and standard deviation of spiritual well-being score and burden of care were 90.36±17.70 and 25.54±11.79, respectively. There was a significant relationship between spiritual well-being (and its components including religious well-being and existential well-being) and burden of care (r=-0.421, P˂0.001). The result of regression test showed that spiritual well-being significantly predicted the burden of care.
Conclusion: The burden of care is experienced by family caregivers during caring for cancer patients, which is related to their spiritual well-being. Therefore, paying attention to the spiritual well-being of these caregivers is emphasized.
 

---

Background & Aim: Concerns over limited equipment and resources particularly in the intensive care units have raised the issues of medical futility, futile treatment, and futile care. Considering that there is no consensus in the definition of the concept of futile care, this study aimed to explore the concept of futile care, especially in terms of clarifying it with the concept of futile treatment.
Methods & Materials: This is a qualitative study conducted using the conventional content analysis approach. In this study, 22 nurses, eight medical specialists, four medical ethics specialists, and one sharia specialist, were purposively recruited with the consideration of maximum variation. Data were collected using individual, in-depth, semi-structured interviews.
Results: The main theme of the study was “care is never futile: care as goal”. This theme is consisted of four main categories including: 1. care as an indispensable service; 2. care as an ongoing process focused on human existence; 3. care as a sacred and essential process in Islam; 4. the necessity for differentiating between care and cure: futile treatment instead of futile care.
Conclusion: Although, in some cases, and depending on the circumstances, medical interventions may be futile, care is never futile. According to the findings of this study, the terms medical futility and futile care cannot be used interchangeably because interchangeable use of these terms can devalue the nature of care. Thus, it is necessary to use the term of “futile treatment” instead of “futile care”.
 

---

Background & Aim: Many patients with cardiovascular disease suffer from some degree of anxiety after admission to the Cardiac Care Unit (CCU). Anxiety adversely affects patients’ recovery. High levels of anxiety increases mortality risk up to three times. This study aimed to determine the effect of pre-operative supportive care plan on anxiety of patients with acute coronary syndrome after admission to CCU.
Methods & Materials: In this clinical trial, 74 patients with acute coronary syndrome, admitted to the Cardiac Care Unit of Vasei hospital of Sabzevar in 2016. Participants were selected via convenience sampling and randomly divided into two groups of intervention and control. The control group only received routine nursing care. For the intervention group, besides routine care, the supportive nursing care was delivered on the intellectual, emotional and physical domains. The Beck Anxiety Inventory questionnaire was completed by both groups before and after the intervention. The data were analyzed by the Mann-Whitney U test and independent t-test using the SPSS software version 16.
Results: Before the intervention, no significant difference was observed in the anxiety score between the intervention and control groups (P=0.162). After the intervention, the anxiety score in the intervention group was lower than in the control group (P=0.023).
Conclusion: According to the results of this study, supportive care plan reduced anxiety in the intervention group compared to the control group. Therefore, supportive care plan is recommended for reducing anxiety in these patients.
Clinical trial registry: IRCT2015123025767N1
 

---

Background & Aim: Nursing care is an essential part of health care services. Missed nursing care is a new concept referring to any aspect of care, that is omitted or delayed. The present study aimed to assess missed nursing care and its related factors from the viewpoints of nurses working in the hospitals affiliated to Kerman University of Medical Sciences in 2017.
Methods & Materials: In this descriptive, cross-sectional study, 300 nurses participated. Two questionnaires on missed nursing care, and its related factors were used for data collection. Data were analyzed through the SPSS software version 20 using descriptive indices.
Results: The mean score of missed nursing care was 32.28±7.41, which was lower than the median (range) of the questionnaire. The highest mean score of missed nursing care and its related factor, respectively were “attending the interprofessional patient care conferences” and “the volume of activities related to patients’ admission and discharge”.
Conclusion: The level of missed nursing care was lower than the median in the present study, which can be lowered by proper management. In addition, by decreasing nurses’ workload, missed nursing care related factors can be reduced.
 

---

Background & Aim: Efforts to improve self-care in patients with heart failure provide better treatment outcomes and longer life expectancy. The purpose of this study was to determine the effect of a caring program based on Pender model on health-promoting self-care behaviors in patients with heart failure.
Methods & Materials: In this single-blind randomized controlled trial, 48 patients with class II or III heart failure, referred to Golestan hospital in Tehran in 2017-2018, were recruited by the purposive sampling method and were randomly assigned to an intervention or a control group. For the intervention group, a caring program based on the Pender Health Promotion Model was conducted in six sessions. Data were collected by the Health Promoting Lifestyle Profile and the Self-Care Heart Failure Index, before and after the intervention. Descriptive and inferential statistical tests were used to analyze the data by the SPSS software version 16.
Results: The mean scores of the dimensions (except self-actualization) and the total score of health-promoting behaviors and self-care in the intervention group were higher than in the control group after the intervention (P<0.05). In addition, after the intervention, the mean scores of the dimensions and the total score of health-promoting behaviors and self-care significantly increased in the intervention group (P<0.05).
Conclusion: Implementing a caring program based on Pender model increases the self-care and health-promoting behaviors of patients with heart failure. Therefore, application of this caring program is recommended for this group of patients.
Clinical trial registry: IRCT20150801023446N17
 

---

Background & Aim: Providing self-care education to patients and their family leads to improvement in the quality of life and increase in participation in self-care programs. The aim of this study was to compare the effect of education by peer and nurse on self-care in hemodialysis patients.
Methods & Materials: In this quasi-experimental study, 105 hemodialysis patients from three selected hospitals in three cities of Isfahan province (Zarinshahr, Falavarjan and Mobarakeh) were selected by the simple random sampling method from February 2016 to September 2016. Three centers were randomly assigned to three groups including education by peer, education by nurse and control. The individual face-to-face education was provided by the peer or the nurse to hemodialysis patients, and the control group only received routine education. Data gathering tool was the hemodialysis patients’ self-care questionnaire which was completed for three groups before and one month after education. The data were analyzed using the SPSS software version 18 through Chi-square test, paired t test, the analysis of variance and Tukey’s post-hoc test at the significance level of P<0.05.
Results: There were no significant differences between the three groups in age, duration of dialysis, gender, and level of education (P>0.05). The Tukey’s multiple comparisons tests showed that the effect of nurse intervention on self-care improvement was significantly more than peer intervention and the control group (P<0.001) and also the effect of peer intervention on self-care improvement was significantly more than the control group (P<0.001).
Conclusion: Education by a nurse is effective in the self-care behaviors of hemodialysis patients and will improve these behaviors. Also, using peer experiences has advantages for hemodialysis patients such as easy, low-cost and effective education, based on life experiences and lack of need for special equipment.
 

---

Background & Aim: Substance use as a crisis and a long-term chronic disorder can lead to psychological burden and reduce the quality of life of family caregivers. The aim of this study was to determine the effect of the quality of life therapy intervention on the burden of the family caregivers of addicts.
Methods & Materials: This is a clinical trial. The research population included all the family caregivers of the recovering addicts, admitted to Baharan psychiatric hospital in Zahedan in 2018. The samples were 80 people who were randomly divided into either intervention or control group. Caregivers in the intervention group received eight sessions of group counseling based on the quality of life therapy and on the basis of the determined content, every other day. Before the intervention and eight weeks after the intervention, the data were collected using the Zarit burden questionnaire and were analyzed by statistical tests through the SPSS software version 21.
Results: Before the intervention, there was no significant difference in the mean score of burden between the two groups (P=0.25). After the intervention, the mean score of family caregiver burden in the intervention group (40.10±12.92) was significantly lower than in the control group (46.80±13.58) (P<0.01).
Conclusion: The quality of life therapy intervention in this study had a positive and significant effect on reducing the burden of family caregivers of addicts. Therefore, it is recommended that healthcare providers use this counseling approach along with addiction treatment programs to improve the psychological well-being of family caregivers.
Clinical trial registry: IRCT20160924029954N11