Medical-Surgical Nursing Journal
Year:2014 | Volume:3 | Issue:3|Papers Count:8

Background and Objective: Disclosure of disease is one of the most complex challenges for individuals who live with thalassemia. This issue is associated with being stigmatized. It is usually associated with anxiety, fear, and negative reactions of other people. Exploring the experience of concealment resulting from thalassemia-related stigma and designing effective interventions is the key to effective treatment and caring of these patients. The present study was conducted to explain the experiences of thalassemia patients and their caregivers concerning disease concealment due to stigmatization.Materials and Method: This qualitative study performed through conventional content analysis approach. The 21 participants with major thalassemia and their caregivers were selected through purposive sampling. The research was performed in the medical facility of Samen Alhojaj, Kerman, Iran, during 2012-2013. Data were gathered through unstructured interviews and field notes. Data analysis was done using conventional content analysis approach.Results: The concept of concealment experienced by patients and their caregivers included the reasons for concealment (disease as a barrier for goal achievement, patient’s personal traits as a barrier for disease disclosure, parents tendency for disease concealment, wrong behaviors and beliefs of the society due to stigmatization of the disease), strategies for concealment (secret caring and lying), and concealment outcomes (physical exhaustion, mental stress, deprivation of support).Conclusion: Patients’ experiences related to thalassemia stigmatization indicated that these patients not only experience adverse physical and mental outcomes of the disease, but also deal with the disease concealment resulting from social stigmatization. The results of the current study can be an introduction to planning interventions to resolve social problems of these patients and help promote their quality of life.

Background and Objective: The quality of hemodialysis can be promoted through reducing vascular access complications in these patients. One of the crucial roles of nurses in hemodialysis wards is reducing inflammation and infection of the vascular access. This study was conducted to compare the incidence of inflammation around the vascular access area in patients undergoing hemodialysis between two antiseptic methods of alcohol after povidone-iodine and the combination of alcohol and povidone-iodine.Materials and Method: This clinical trial was performed under the supervision of Mashhad University of Medical Sciences, Iran, after gaining ethical committee approval in 2014. In the present study, 100 participants were selected by convenience sampling method and randomly divided into three groups of combination of alcohol and povidone-iodine (n=37), alcohol after using povidone-iodine (n=32), and control group (n=31). In the intervention groups 1 and 2, vascular access was disinfected using a combination of alcohol and povidone-iodine and alcohol after povidone-iodine, respectively. In the control group, vascular access was disinfected using the method of the related ward. Patients were fully observed for phlebitis occurrence for 12 hemodialysis sessions (1 month). Vascular access was controlled using the Iranian Nurses Association's phlebitis criteria. Data were analyzed using chi-square, ANOVA test, and Fisher's exact test in SPSS version 16.Results: The incidence rate of inflammation in the combination of alcohol and povidone-iodine, alcohol after povidone-iodine, and control groups, respectively, were 46%, 87.9%, and 100%. The incidence rate of inflammation was significantly lower in the combination of alcohol and povidone-iodine compared to the alcohol after povidone-iodine group (P<0.001). However, no significant differences existed between the alcohol after povidone-iodine and control group.Conclusion: The combination of alcohol and povidone-iodine is a simple, inexpensive, and most importantly effective method of reducing the incidence of vascular access inflammation in patients undergoing hemodialysis. Thus, it can be used as a vascular access disinfection method in hemodialysis wards.

Background and Objective: Pain in neonates may have adverse impacts. Therefore, relieving pain through harmless, simple, and applicable methods, in order to prevent its dangerous consequences, is of great importance. The aim of the present study is to determine the impact of oral sucrose on relieving nasogastric tube insertion pain in premature neonates.Materials and Method: The present study is a crossover clinical trial on 38 preterm infants (gestational age between 28-34 weeks) hospitalized in Bistonoh-e-Bahman Hospital, Tabriz, Iran, in 2013. The subjects were selected by convenience sampling and divided into two groups using randomized block design. In the first group, nasogastric tube insertion was carried out in the routine way for the first time, and for the second time, by administration of oral sucrose. In the second group, the procedure was performed in the reverse order of that in the first group. In both groups the emerging pain was measured by the Premature Infant Pain Profile (PIPP) tool 2 minutes before, during, and 5 minutes after the procedure. Data were analyzed using, chi-square t-test, Students' independent test, paired t-test, and repeated measures ANOVA in SPSS version 18 to examine the trend of change in pain in time. P values of less than 0.05 were considered statistically significant.Results: The results showed that oral sucrose reduces the pain response of infants. The mean pain score during the insertion of nasogastric tube and administration of oral sucrose was 5.95±2.35 and during routine procedures was 9.93±2.89 (P<0.001). The mean pain score 5 minutes after insertion of nasogastric tube with administration of oral sucrose was 3.66±0.57 and routine procedure was 6.38±0.83 (P=0.017).Conclusion: It was revealed that oral sucrose can relieve pain caused by nasogastric tube insertion. Therefore, its implementation as a harmless and simple method can reduce pain in preterm infants.

Background and Objective: Surgical hand antisepsis is a necessary procedure for the prevention of surgical site infection (SSI). Today, higher efficacy of alcohols has resulted in the worldwide use of alcohol-based disinfectants. This study was conducted in order to compare the disinfectant effect of Decosept hand rub (routine method) with that of Betadine-ethanol (experimental method) on hand bacterial flora.Materials and Method: This before and after clinical trial was performed on 20 healthy volunteers in 2012. The participants were selected from students and staff of Hamadan University of Medical Sciences, Iran, using convenience sampling. All research units performed both interventions. In each method, after washing both hands, first sample (prevalue) was taken from fingertips of hands, then hands were scrubbed with Decosept and immediately the second sample (immediate) was taken from one randomly selected hand. After that, they put on a sterile glove on the other hand and 3 hours later the third sample (3h) was taken from fingertips of the same hand. At least one week later, the experimental method was performed. Results were reported as colony-forming unit per milliliter (cfu/ml). To assess effectiveness of solutions, reduction factor (RF) was calculated. Data were analyzed using paired t-test in SPSS version16.Results: Evidently, both antiseptics resulted in the reduction of cfu/ml immediately and 3 hours after disinfection. Mean log10 hand bacterial count before and immediately after disinfection with Decosept were 4.07, 0.81, respectively, and in the second hand before and 3 hours after were 1.94 and 3.87, respectively. paired t-test showed a significant difference between prevalue cfu, and immediate and 3h cfu in both methods. However, the immediate RF and 3h RF of Decosept were higher than Betadine- ethanol (P=0.0001).Conclusion: The effectiveness of the experimental method on skin bacterial flora of the hand was lower than the routine method. Hence, it is recommended that operation room nurses and surgeons use Decosept for hand antisepsis before surgery.

Background and Objective: Febrile convulsion is one of the most common neurologic disorders in children aged 6 months to 6 years. Considering the probability of recurrence and the crucial role of mothers in controlling the disease, we conducted the present study to explore the effectiveness of a febrile convulsion control educational program on the knowledge, attitude, anxiety, and action of mothers.Materials and Method: This quasi-experimental study was performed in Shahrekord, Iran, on 130 mothers of children who had experienced febrile convulsion in 2013. The participants were selected using convenience sampling method and randomly divided into two intervention and control groups. The data were gathered before and after the educational program using demographic, knowledge, attitude, anxiety, and action questionnaires. The data were analyzed using SPSS software version 20, Students' independent t-test, paired t-test, and multiple regression tests.Results: The results of Students' independent t-test showed a significant difference in mean scores of knowledge, attitude, anxiety, and action (P<0.001) The results of multiple regression tests showed a significant correlation between mothers' attitude and their age (P=0.009) and child's birth order (P=0.010), between mothers' anxiety and child's age (P=0.040), and the mothers' action and their occupation (P=0.040).Conclusion: This study confirmed the efficiency of educational interventions in increasing knowledge, improving attitude and action, and reducing anxiety of mothers regarding prevention of febrile convulsion in children. Therefore, it is proposed that conducting appropriate educational programs for mothers be added to the job description of nurses.

Background and Objective: Venous catheter is one of the most painful medical procedures and frequently practiced in the children's thalassemia ward. Children with thalassemia experience moderate to severe pain during phlebotomy. The present study aimed to investigate the effect of huko point massage with ice on intensity of pain due of Phlebotomy In children with thalassemia. The relationship between anxiety and pain in children was also studied.Materials and Method: A randomized, clinical trial was conducted on 86 children of 6-12 years of age undergoing transfusion and referred to the thalassemia ward of Kerman Samen Alhojaj Medical Center in 2014. The children were selected using convenience sampling and assigned to the interventional and control groups using randomized block design. In the interventional group, 5 minutes before performing phlebotomy, huko point massage with ice was performed. In the control group, no intervention was performed. Data were collected using a demographic questionnaire and the Face, Legs, Activity, Cry, Consolability Scale (FLACC scale). Data were analyzed using Spearman's correlation and Mann-Whitney test by SPSS software version 22.Results: The mean pain score in the interventional group was 0.65±0.75 and in the control group was 3.81±1.84. A significant difference was observed between the pain severity of the two groups (P=0.001).Conclusion: Huko point massage with ice can reduce intensity of pain due of phlebotomy in children with thalassemia. Accordingly, the application of huko point massage with ice is recommended as a non-pharmacological method of pain relief during phlebotomy in children with thalassemia.

Background and Objective: Hypertension is a preventable health risk. Thus, it is necessary to pay attention to hypertention in order to decrease macrovascular and microvascular complications of diabetes mellitus. This study examines the effect of the self-care program on the blood pressure of patients with diabetes.Materials and Method: This study was a randomized clinical trial performed on 134 patients with type 2 diabetes in the Diabetes Center in Sirajn, Iran, in 2011. The participants were assigned randomly into 2 groups of intervention and control (n=67) using a random number table. The study tools consisted of a demographic information questionnaire and sphygmomanometer. The blood pressure of participants in both groups was measured before the intervention and every month during the intervention (for 3 months). The self-care program was conducted according to regulatory protocols in 6 sessions of 90 minutes for 6 weeks in the intervention group. Data were analyzed using SPSS software version 15, and descriptive statistics (mean, relative frequency) and repeated measure ANOVA, chi-squared test.Results: No difference was observed between mean systolic blood pressure of the two study groups after the intervention at different times of measurement. However, mean diastolic blood pressure of the two groups showed a significant difference (P=0.001).Conclusion: The results showed that implementation of the self-care program can reduce diastolic blood pressure in type 2 diabetic patients. Therefore, the use of this program is recommended in diabetic patients in order to control diabetes complications.

Background and Objective: Caring is the core of nursing; however, different individules have different perceptions of it. Continuous assessment and measurement of caring behaviors results in the identification of their problems. The careful planning of interventions and problem solving will improve care. The aim of this study was to identify nurses' perception of caring behaviors in the intensive care units.Materials and Method: In this descriptive-analytic study, 140 nurses were selected from intensive care units of hospitals affiliated to Lorestan University of Medical Sciences, Iran, using the census method in 2012. The data collection tool was the Caring Behaviors Inventory for Elders (CBI-E). This questionnaire consisted of two parts including demographic information and 28 items related to care. Face and content validity of the Persian version of the questionnaire were provided by professionals, and after deletion of 4 items a 24-item questionnaire was provided. Cronbach's alpha coefficient was calculated to assess reliability (a=0.71). Data were analyzed using SPSS software version 18 and descriptive-analytic statistics (Kruskal-Wallis test and Mann-Whitney test).Results: Based on the findings, nurses paid more attention to the physical-technical aspects (95.71±12.76) of care in comparison to its psychosocial aspects (75.41±27.91). Nurses had the highest score in care behavior of "timely performance of medical procedures and medication administration".Conclusion: Since nurses paid more attention to the technical aspects of care than its psychosocial aspects, by providing nurses with a correct perception of care, patients can be provided with needs-based care. This will increase patient satisfaction with nursing care, and indirectly result in the positive attitude of patients and society toward the nursing profession and its services. Moreover, nursing education officials can use these results to assist nurses in meeting patients' needs and expectations in clinical practice.