---

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.

---

Background & Aim: Decreasing mechanical ventilation and early extubation after cardiac surgery are the important scientific subjects that their clinical and financial benefits had been demonstrated. There are some variables that are associated with extubation time so, determination of them will help nurses to plan appropriate care aimed at doing an early and safe extubation.

Methods & Materials: The purpose of this descriptive-analytic study was to determine whether any preoperative variable had a significant effect on extubation time after CABG. The research was conducted in one of hospitals in Tehran city. In this retrospective study, data were collected by reviewing of files of eligible patients who were undergoing CABG from December 2003 to March 2005. 93 files reviewed by convenience sampling method. Collecting data tool was a checklist consists of three parts: 1) demographic characteristics 2) health and disease history 3) physiologic status. Samples divided into two groups: early and delayed extubation (>6h). Data analysis was performed by descriptive methods, chi square, fisher exact test and regression analysis.

Results: Mean and standard deviation of duration time of intubation was 7.19±3.00 with range of 3-18.25 hours in all samples. Totally 43% of subjects extubated in ≤6h and 57% of them in >6h. Age was the only preoperative variable that was found to be statistically significant to extubation time (p=0.01).

Conclusion: According to our findings age is associated with postoperative intubation time after CABG. It means older patients need to be under long mechanical ventilation. So, nurses should make a decision on extubation in older patients, carefully.

---

Background & Aim: Anxiety is one of the emotional conditions among patients scheduled for surgery that can result in increasing postoperative pain, increasing analgesic and anesthetic requirements and prolonging hospital stay. The aim of this study was to assess the effectiveness of acupressure (acupuncture without needle) in reducing patients&apos anxiety before abdominal surgeries.

Methods & Materials: In this randomized, blinded, sham controlled trial, 70 patients who were scheduled to undergo abdominal surgery in Tehran University of Medical Sciences&apos hospitals were selected using convenience sampling method. The patients were randomized to an acupressure group (n=35) or a placebo group (n=35), receiving acupressure either at the right points (Yintang and Shen men) in acupressure group or at sham points in the placebo group for 10 min. Anxiety was recorded on a Visual Analog Scale (0-10). Vital signs were measured before and after pressure application in both groups.

Results: The anxiety was decreased in both groups following pressure application for 10 min (P<0.001). The amount of anxiety was significantly different between the groups (P<0.001). The heart rate, respiratory rate, and diastole/systole pressure (P<0.001) were decreased in the case group. Only heart rate (P=0.016) and respiratory rate (P=0.007) were decreased in the placebo group. Changes in respiratory rate and systole pressure following pressure application were statistically significant between two groups.

Conclusion: Acupressure at the right points can decrease anxiety before abdominal surgeries but it has no clinical effect on vital signs.

---

Background & Aim: Surgery is a stressful experience. Fear of postoperative pain causes anxiety. The purpose of this study was to investigate the effect of patient education about pain control on patients&apos anxiety before abdominal surgery.
Methods & Materials: In this quasi-experimental study, 89 patients who were planned to undergo elective abdominal surgery in an educational hospital were recruited to the study. Informed consents were obtained. The participants were randomly allocated in two control (n=45) and experimental (n=44) groups. The questionnaire included demographic information, clinical characteristics, and the Spielberger&aposs State Trait Anxiety Inventory (STAI). Patients in the experimental group received education about pain control one day before surgery. The education method was oral explanation for 20-30 minutes. The control group received no intervention. Data were analyzed through descriptive and inferential statistics (chi-square, t-test, Fisher&aposs exact test, Wilcoxon signed ranks and Mann-whitney&aposs tests) in the SPSS.
Results: Findings indicated that there was a significant difference in anxiety level between the experiment and control groups before surgery (P<0.001). There was also a significant difference between anxiety level in the surgery day (P<0.001) between the two study groups. The anxiety level was significantly decreased in the experiment group.
Conclusion: Based on our findings, patient education about pain control led to reduce preoperative anxiety in patients undergoing abdominal surgery. Patient education is a non-medical simple intervention that is recommended for using in surgery wards.

 

---

Background & Aim: Postoperative nausea is a common problem after general anesthesia, especially in ambulatory surgery. In ocular surgeries including strabismus surgery, intraocular pressure increase may lead to eye damage. Drug therapy has various side effects. The purpose of this study was to evaluate acupressure on nausea in patients undergoing strabismus surgery.

Methods & Materials: In this double-blinded clinical trial, 60 patients undergoing strabismus surgery were allocated into intervention and control groups. In the intervention group, a sea-band was placed on the P6 point of patients&apos wrists 30 minutes before induction of anesthesia. In the control group, the sea-band was placed in the opposite position of the patients&apos wrists. Data were collected during six hours after surgery in the recovery room. Data were analyzed using Chi square, t-test, and Mann-Whitney tests.

Results: There were no differences in demographic and surgical characteristics between the two groups at baseline. The intensity of nausea in the recovery room (P=0.002) and six hours after surgery (P<0.001) were significantly less in the intervention group than the control group.

Conclusion: Based on the findings of this study, acupressure decreases post operative nausea. Acupressure is a simple, noninvasive and cost- effective intervention which can be applied by nurses to prevent post operative nausea.

---

Background & Objective: Hospitalization of patients in the intensive care unit of open heart surgery (ICUOH) is often stressful for patients&apos family carers. This study aimed to investigate the effectiveness of the informational support on anxiety among families of patients undergone open heart surgery.

Methods & Materials: In this double-group randomized clinical trial, 64 family carers of patients undergone open heart surgery were selected using convenience sampling method and were randomly allocated into two intervention or control groups. The informational support consistedof  holding the ICU orientation tours and educational sessions, and providing educational pamphlets and booklets. The members of the control group received routin information. The anxiety of the family carers was measured using the trait Spielberger anxiety questionnaire before surgery and in the day of discharge from the ICU. Independent and paired t-tests were used to analyze the data.

Results: According to the findings, there were no significant difference between the two groups regarding demographic charachteristics. At the baseline, the mean of anxiety scores were 47.9±11.5 and 49.2±11.5 in the control and intervetion groups, respectively. The anxiety scores diminished in both groups after the surgery, however, the difference was not statistically significant between the two groups (P=0.18).

Conclusion: For effective control of anxiety among family members of patients, both informational support and other supportive techniques such as psychological support and meeting other family needs should be considered.

---

Background & Aim: Sedation after coronary artery bypass graft surgery can prevent the side effects of the treatment. The purpose of this study was to determine the effect of controlled sedation based on the Richmond scale on the duration of mechanical ventilation and the changes of blood pressure in patients following coronary artery bypass graft surgery.
Methods & Materials: In a single blind randomized clinical trial (IRCT2017050517693N2) from June to August 2017, a convenience sample of 80 patients after coronary artery bypass graft surgery, hospitalized in the intensive care unit of Heshamat Center, Rasht, were selected and randomly allocated into two groups (each group=40). Sedative drug dose was determined using the Richmond agitation sedation scale in the intervention group and determined routinely (based on hemodynamic changes) in the control group. Pain as a confounding variable was evaluated using CPOT tool. Data were analyzed by descriptive statistics and Chi-square, Mann-Whitney, independent t-test and repeated measures ANOVA using the SPSS software version 22.
Results: The mean age of samples was 59.89±7.53 and 66.7% of them were male. There was a significant difference between two groups in the duration of mechanical ventilation (P<0.04), the changes of patients’ blood pressure (P<0.05), need for a vasopressor drug (P<0.05) until extubation and need for the first administration of sedatives (P<0.001).
Conclusion: Utilizing the Richmond tool can reduce the patient’s dependence on ventilator and changes in arterial pressure. Also, using this tool can prevent unnecessary and early administration of sedative and vasopressor drugs in patients.
 
 

---

Background & Aim: Designing healthcare spaces and physical facilities requires the identification of the patient's family needs, and it is considered an important component of nursing theories. The aim of this study was to explain the needs of family caregivers of patients undergoing gynecological surgery for physical facilities and equipment in hospital.
Methods & Materials: This study is based on the results of the qualitative part of a large hybrid study on the development and implementation of a need-based service delivery program for the caregivers of patients undergoing gynecological surgery in 2017. The selection of participants was purposefully done with maximum variation. The study data were collected using 31 (16 caregivers, 6 nurses, 4 doctors, 3 patients and 2 service workers) in-depth interviews and observations and analyzed by the conventional qualitative content analysis using the Zhang and Wildemuth approach.
Results: Data analysis led to the development of the theme "need for physical facilities", which fell into two categories "need for proper physical structure in the hospital" with the following subcategories: "need for care facilities behind the operating room door", "need to provide welfare facilities in the hospital for caregivers", "need for welfare facilities in the surgical ward", "necessity of allocating rooms to the similar patients", and category "need for appropriate hospital facilities and equipment" with subcategories "caregiver’s need for facilities and amenities", and "caregiver’s need for facilities and amenities for the comfort of the patient".
Conclusion: The results show the importance of having a physical structure tailored to the needs of family caregivers as well as the availability of appropriate facilities and equipment in hospital. One of the limitations of the study was preventing men from visiting patients in the women’s hospital. It is recommended that the needs of male companions and the necessity of their presence according to the cultural context be studied. Also, a new architectural design is suggested to create a suitable therapeutic environment and positive effect on patients’ improvement and increase patient and family satisfaction.
 

---

Background & Aim: Gastrointestinal ostomy surgery changes the normal digestive function of patients. Insufficient knowledge and skills regarding ostomy care can lead to physical, psychological, and social complications. The present study aimed to determine the effect of a pre-operative education program on ostomy self-efficacy in patients undergoing ostomy surgery.
Methods & Materials: This randomized clinical trial included patients scheduled for colostomy or ileostomy surgery at hospitals affiliated with Shahid Beheshti University of Medical Sciences during 2022-2023. Participants were randomly assigned to two groups: the intervention group (41 patients) and the control group (44 patients). The control group received only routine education before discharge, while the intervention group participated in the pre-operative education program. The modified ostomy self-efficacy questionnaire was administered to patients before the intervention and one month post-surgery. Data were analyzed using descriptive and inferential statistics in SPSS software version 20.
Results: One month after surgery, the ostomy self-efficacy scores were significantly higher in the intervention group compared to the control group (P<0.001). Furthermore, within the intervention group, the post-intervention ostomy self-efficacy scores were significantly greater than pre-intervention scores (P<0.001). Additionally, the length of hospitalization following surgery was significantly shorter in the intervention group than in the control group (P=0.007).
Conclusion: The results showed that pre-operative education enhances ostomy self-efficacy and reduces the length of hospitalization. Therefore, implementing pre-operative education on ostomy care for patients undergoing ostomy surgery is strongly recommended.
Clinical trial registry: IRCT20220731055588N1