پرستاری داخلی و جراحی
سال:1399 | دوره: | شماره: |تعداد مقالات:8

Background: Tuberculosis (TB) aff ects various aspects of quality of life (QoL), and self-care is the most important form of primary care and one of the main factors involved in the process of treating chronic diseases and improving the patients’ QoL. Objectives: This study aimed to investigate the eff ect of self-care education on the QoL of TB patients. Methods: In this quasi-experimental study, 110 TB patients referred to the TB coordinating Center in Zahedan, Southeastern Iran, in 2018, are studied. Participants were selected using convenience sampling and were randomly assigned to the intervention (n = 55) and control (n = 55) groups. Data were collected using the tuberculosis quality of life-version 2 (TBQol-v2). For the intervention group, fi rst, patients and their caregivers were divided into groups compromising of 4 to 6 members, and then three sessions of self-care education, including lectures and questions and answers meetings, each lasted for 30 minutes (in total 90 minutes) were provided to each group. Data were analyzed in SPSS version 21 using descriptive statistical tests, independent t-test, paired t-test, and chi-squared test. Results: Mean of the total QoL score of the two groups before the intervention was 67. 56  5. 99 and 67. 09  5. 03, respectively, indicating no signifi cant diff erence (P = 0. 65). But after providing the intervention, the mean score of patients QoL in the intervention group (74. 84  4. 90) was signifi cantly higher than the control group (67. 98  0. 68) (P = 0. 001). Conclusions: Since self-care education can eff ectively enhance the QoL of TB patients, it is recommended to provide such educations for both treatment and follow-up of these patients along with directly observed treatment, short-course (DOTS).

Background: Premature babies face nutritional problems caused by underdevelopment and lack of coordination between sucking, swallowing, and breathing. Appropriate early interventions are needed to promote the nutritional adequacy of these infants. Objectives: This study was designed to compare the eff ect of breast milk odor and incubator cover on the nutritional adequacy of premature infants. Methods: A quasi-experimental study was conducted on 105 preterm infants aged 28-33 weeks who were admitted to the Neonatal Intensive Care Unit (NICU) of Ali Ibn Abi Taleb Hospital in Zahedan in 2018. The subjects were selected via convenience sampling and randomized into three groups: breast milk odor (BMO), incubator cover (IC), and control. Infants in the IC group were placed in an incubator for two hours before feeding. In the BMO group, a gauze soaked with breast milk was placed 1. 5 cm away from the infant’ s nose in the incubator, and a prescribed amount of milk was given by a syringe to the infant through the mouth. The amount of milk that the baby orally received in the fi rst 10 min (nutritional adequacy) was recorded by a camera, and the results were compared in the three groups. Results: One-way analysis of variance showed a statistically signifi cant diff erence between the control group and the two groups of incubator cover and breast milk odor (P < 0. 001) such that nutritional adequacy was lower in the control group than in the two other groups. Conclusions: Both the smell of breast milk and incubator cover improved the nutritional adequacy of premature infants and enabled them to orally receive more breast milk.

Background: Since stroke cause chronic and long-term complications and still no pre-discharge rehabilitation program is developed for such patients, home-based rehabilitation is an appropriate caring approach for these patients. Objectives: The present study aimed to explore the eff ect of home-based rehabilitation on adherence to treatment and quality of life (Qol) of individuals after stroke in 2019. Methods: In this quasi-experimental study 60 stroke patients admitted to the internal medicine and neurology department of hospitals affi liated to the Zahedan University of Medical Sciences, southeast of Iran, during 2019 are studied. Subjects were selected by convenience sampling and then randomized into the intervention and control groups. Data were collected using the Adherence to Treatment Regimen questionnaire and Stroke Specifi c Quality of Life scale, which were completed in two stages one and three months after the intervention. In the intervention group, rehabilitation training was provided in three 45-minute sessions during the hospital stay. After discharge, the training content was followed at home twice a week for two weeks (four times in total). Data were analyzed in SPSS-22 using repeated measures ANOVA, independent t-test, and chi-squared test at the signifi cance level of P < 0. 05. Results: The mean total scores of QoL and adherence to the treatment regimen and its dimensions one and three months after rehabilitation were signifi cantly diff erent in the two groups, with the intervention group scoring higher than the control group (P < 0. 001). Repeated measures ANOVA indicated a statistically signifi cant diff erence between the two groups regarding the eff ect of time and group on the QoL and adherence to the treatment regimen and its dimensions. In other words, the intervention and time aff ected the mean QoL and adherence to the treatment regimen, which resulted in a signifi cant diff erence concerning the time intervals (P < 0. 001). Conclusions: This study showed that home-based rehabilitation improves treatment adherence and QoL in stroke patients; therefore, employing this method by nurses to engage the family of patients with chronic diseases in the process of treatment is recommended.

Background: Thalassemia can aff ect diff erent aspects of life the same as any other chronic disease. Despite therapeutic measures of thalassemia, the patient and families encounter several physical and psychological problems. Having a child with thalassemia can disrupts the family mental balance. Objectives: The purpose of this study is to explain the consequences of parents who have children with thalassemia. Methods: Inductive qualitative approach was applied in 2017-2018 in Hajar Hospital. Semi-structured interviews were conducted for data collection. Qualitative conventional content analysis was employed for data analysis. 10 fi ve mothers, one grandmother, and two fathers and nurses participated in this study. Results: The three specifi ed categories were as follows: (1) Non-acceptance of disease: disbelief, not following up treatment, and interest for abortion, (2) parent psychological reactions: unhappiness, anxiety, and mental confusion, (3) Isolation: dissociation and stigma. Conclusions: Parents who had children with thalassemia experienced several psychological problems. The consultative and supportive services of the health system were necessary for these parents. Also, it was urgent that the health authorities establish consulting clinics for chronic diseases to provide them the required consulting services.

Background: Urinary tract infection is the most common site of infection associated with health care in the Intensive Care Unit (ICU) patients. Long-term catheterization is the most important risk factor for Urinary Tract Infections (UTIs). These infections are more common in women than in men. Colonized microorganisms in the perineal skin and around the urethra may move into the urinary system through the external surfaces of the urinary catheter to cause infection. Objectives: The present study aimed to compare the eff ect of perineal care with normal saline and 2% chlorhexidine solution on the rate of catheter-associated urinary tract infection (CAUTI) in women hospitalized in ICUs. Methods: A quasi-experimental study was performed on 70 female patients hospitalized in the ICU of Khatam-Al-Anbia Hospital of Zahedan in 2019. The research units meeting the inclusion criteria were selected using convenience sampling and then randomly divided into two groups of normal saline (n = 35) and chlorhexidine (n = 35). The perineal area of patients in the fi rst group was washed with normal saline and the second group with 2% chlorhexidine solutions twice a day for seven days in both groups. To diagnose UTIs, urine samples were cultured on the fi rst and seventh days. Data were analyzed using SPSS 21 via the independent t-test, chi-square test, and Fisher’ s exact test at a signifi cance level of less than 0. 05. Results: Finally, 60 participants completed the study. The two groups did not diff er signifi cantly in terms of age, marital status, level of education, cause of hospitalization, antibiotic use, underlying diseases, fl uid intake, and urinary output. At the end of the seventh day after the intervention, the incidence of UTIs was signifi cantly lower in the chlorhexidine group (13. 3%) than in the normal saline group (76. 7%) (P = 0. 001). Conclusions: The results showed that washing the perineal area every 12 hours with 2% chlorhexidine solution compared to normal saline reduces the incidence of CAUTIs in women hospitalized in ICUs. Therefore, perineal care with a 2% chlorhexidine solution is recommended for perineal care of female patients with urinary catheters hospitalized in ICUs.

Background: Agitation in mechanically ventilated patients with decreased consciousness is a challenge in the ICU and a threat to the process of mechanical ventilation. On the other hand, controlling agitation through medication and imposing physical limitations is associated with a number of undesirable side eff ects. Objectives: This study aimed to determine the eff ect of auditory and tactile stimulation by a family member on the level of agitation in patients with traumatic brain injury (TBI) and decreased consciousness. Methods: This quasi-experimental study was performed on 80 TBI patients with decreased consciousness who were admitted to the ICU of two teaching hospitals in southeastern Iran in 2019. Qualifi ed patients were selected by convenience sampling and then randomized into the intervention (n = 40) and control (n = 40) groups. Data collection tools included a demographic form and the Richmond Agitation and Sedation Scale (RASS). For patients in the intervention group, the researcher fi rst completed the demographic form and the RASS. Then, they underwent the experiment, which consisted of auditory and sensory stimulation by a family member for 10 minutes. After 30 minutes, the agitation level was measured again. This experiment was performed for seven consecutive days between 16: 00 and 18: 00 o’ clock. Patients in the control group, however, did not receive any intervention other than routine care in the ICU. Data were analyzed in SPSS version 21 by using descriptive statistical tests and independent t-test, paired t-test, [analysis of] covariance, and chi-square test at the signifi cance level of P < 0. 05. Results: The results indicated no signifi cant diff erence in the level of agitation in the intervention and control groups between the fi rst and fi fth days; however, independent t-tests and analysis of covariance revealed that the patients who received auditory and tactile stimulation on the sixth and seventh days experienced signifi cantly lower levels of agitation than the control group (P < 0. 01). Conclusions: Auditory and tactile stimulation by family members is eff ective in decreasing the agitation of TBI patients with decreased consciousness. Therefore, it is suggested as a helpful intervention in nursing care programs.

Background: Cesarean section (C-section) not only is associated with health risks for both mother and child, but also is costly. Csection rates are on the rise worldwide. In Iran, it is becoming a major challenge for current population policies. Objectives: The current study aimed to investigate the main factors of the tendency to C-section in Iran. Methods: In this cross-sectional study 320 pregnant women admitted to health centers in Lorestan province (west of Iran) in 2019 are included. Participants were selected using the multi-stage cluster sampling technique. Data were collected using a demographic form, the Fear of Pain Questionnaire, and the Knowledge and Attitude about Delivery Methods scale. Descriptive statistics and multivariate logistic regression model were employed to analyze the data using the Stata version 14. Results: 48. 44% of participants preferred cesarean delivery. The mean scores of fear of pain in the C-section and vaginal delivery groups were 39. 98  8. 21 and 36  8. 62, respectively, indicating a signifi cant diff erence (P < 0. 001). Level of education of the husband (OR = 2. 79), income (OR = 5. 9), fear of labor pain (OR = 1. 04), history of C-section, and improved attitude toward C-section (P < 0. 001) were directly associated with increased tendency to C-section (OR = 0. 36); in contrast, female gender of the fetus (OR = 0. 36), increased BMI (OR = 0. 75), and improved attitude toward vaginal delivery were indirectly associated with women’ s tendency to C-section. Conclusions: This study showed that while many pregnant women prefer vaginal delivery, the tendency to C-section in Lorestan province is high, which reveals the need to design and implement eff ective interventions and programs to reduce unnecessary Csection and promote vaginal delivery. Educating families, especially pregnant women, about the advantages and disadvantages of delivery modes, promoting and using new low pain techniques of vaginal delivery, and increasing women’ s participation in childbirth preparation programs are eff ective measures that can reduce the rate of unnecessary C-section.

We herein introduced a 3 years old girl, who is a rare case of penetrating intracardiac damage severely induced by the abnormal movement of a sewing needle form the right lung toward the heart and entering in the right ventricle, which created Right Pneumothorax and right side bleeding. In clinical examinations, all vital symptoms were normal, and there was no sign of Cardiac tamponade, except reduced sound in the right lung base. Also, the external object was retained in the midclavicular line between the third rib, which was signifi cant. In the Simple posterior-anterior and lateral graphics of chest radio opacity linear image on the lower part of the heart, the shadow was also signifi cant. This is a rare case of abnormal needle movement from the right thorax to the right ventricular apex, which caused pulmonary problems. Following necessary diagnostic tests, a surgery was performed to remove the needle from the patient’ s chest without open-heart surgery and CPB. Finally, 3 days after the operation, the patient was discharged from the cardiac surgery service in good general condition.