Journal of Multidisciplinary Care
Year:2020 | Volume:9 | Issue:2|Papers Count:8

Background & Aims: Patients undergoing hemodialysis are exposed to various physical, psychological, and social stressors. Self-care activities can play a significant role in adapting to the disease process and improving their quality of life. In addition, using the PRECEDE-PROCEDE model, an appropriate scale can be obtained from these patients’ perceptions, knowledge and attitudes toward their self-care and self-care knowledge, and based on this model, the relationship between factors and patients’ self-care ability can be assessed. Therefore, the researchers decided to conduct a study predicting PRECEDE model constructs with self-care in patients undergoing hemodialysis. Methods: This cross sectional study was performed on 80 patients referred to the Lordegan hospital. Quality of Life, health status, predisposing factors (knowledge and attitude), enabling, and enhancing along with self-care behaviors of hemodialysis patients were completed by interview. The reliability and validity of the questionnaires were confirmed. Data were analyzed by SPSS software using Pearson correlation coefficient, ANOVA, t-test, and regression analysis. Results: The mean and total deviation of self-care behaviors score was 32. 38 ± 12. 83. 56. 5% of people had poor self-care, 42. 5% had moderate self-care, and 0. 2% had good self-care. In addition, Pearson correlation test showed a significant relationship between PRECEDE-PROCEDE model items (reinforcing factors, enabling factors, and predisposing factors) and self-care (P <0. 05). According to the results of regression analysis, the predictive power of the items of precession-process model (reinforcing factors, enabling factors and predisposing factors) was found to be 0. 419. Conclusion: Considering the lack of self-care, behavior of hemodialysis patients and the need for a direct correlation between PRECEDE model constructs, appropriate interventions are recommended, especially educational interventions to promote self-care and increased emphasis on self-care.

Background & Aims: loneliness has some implications for health. The relationship between loneliness and nutritional status requires careful and principled investigation. Therefore, the aim of this study was to determine the relationship between loneliness and nutritional status of the elderly. Methods: 440 elderly 60 years and older individuals from Social Security Administration, Education Retirees Association, and Health Center were selected randomly Descriptive-Analytical study in 2018. Data collection tools included demographic information questionnaire, UCLA loneliness scale (20-80 Score in four levels; without loneliness, low, moderate and high) and mini nutritional assessment (0-30 score at three levels of malnutrition, at risk of malnutrition and normal nutritional status). Results: The Mean ± SD age for the participants was 65. 32(6. 22). The relationship between nutritional status and loneliness of 68 elderly people without feeling alone (<20), 85. 3% had normal nutritional status, of 317 elderly people with low loneliness (39-21), 80. 4% had normal nutritional status. Of 52 elderly people with moderate loneliness (59-40), 63. 5% were at risk of malnutrition. Loneliness in the elderly was significantly associated with an increased risk of malnutrition (OR = 4. 2276, P = 0. 00). Conclusion: According to the felling of loneliness, more than half of the elderly and the reverse connection between the feelings of loneliness with the state of nutrition, holding free consultation classes in order to reduce the feeling of retired elderly loneliness by the politicians of the health system.

Background & Aims: ICU is one of the vital departments in the hospital to reduce mortality and morbidity. The department where nurses face complex situations that require decision-making skills. In fact, problem solving is an important and complex issue clinical practice, and decision-making is an important indicator. The purpose of the study was to investigate the effect of SBAR-based patient safety education program on nurses’ clinical decision making in intensive care unit nurses. Methods: The quasi-experimental study was performed on 60 nurses working in intensive care units of Ayatollah Kashani and Hajar hospitals in Shahrekord, Iran in 1398. The subjects were randomly assigned to two experimental and control groups (30 people each). For the experimental group, five SBAR-based training program was held (Situation, Background, Assessment, and Recommendation). Data were collected using Lori et al. (2001) clinical decision making questionnaire before and one month after the intervention respectively. The collected data were analyzed using analysis of covariance in SPSS software (version 22). Results: According to the findings, the clinical decision-making score of the test group nurses before the intervention was 69. 1± 5. 44 and after the intervention was 80. 8 ± 7. 22 (P<0. 001). In the control group, it was 70. 6 ± 6. 94 before intervention and 71. 1 ± 6. 72 after intervention (P = 0. 214). The rate of changes in the experimental group was 11. 7 ± 3. 79 and in the control, group was 0. 53 ± 2. 3. The results of the study showed that the implementation for the patient safety-training program based on SBAR technique had a significant effect on the mean score of clinical decision making of nurses. Conclusion: The program training based on SBAR technique is effective on nurses ‘ clinical decision-making. Therefore, it is suggested that HEC and planners benefit from this technique.

Background & Aims: Ebstein’ s anomaly is an abnormal displacement downward of Tricuspid valve into the right ventricular, which is accompanied by myopathy of the right ventricular. It is found rarely with the prevalence of approximately 1: 20000. Since the diagnosis of this disease in the appropriate position and time, the management of patients is important. This infant with Ebstein’ s anomaly is reported as a case report. Hajar Hospital, Shahrekord Methods: The patient was a girl infant born due to heart drop through Cesarean on Nov 20, 2019 achieved G1Ab0L1 with GA = 35w+ 6d. The infant was transferred to the NICU ward of Hajar Hospital due to the Hypotone and HR<100 with NCPAP after initial procedures. The fetal echo and ultrasonography of neonate reordered cardiomegaly, pleural effusion and large ASD. Echocardiogram performed at birth showed severe Einstein’ s anomaly, PDA, ultra-thin pulmonary and pulmonary valve atresia. Conclusion: The Ebstein’ s anomaly is a rare disease with a prevalence of 1: 20000 births and based on the severity of involving in patients is caused different symptoms. Recognition and diagnosis on time of the disease and treatment of its complications decreases the rate of mortality.

Background & Aims: Nowadays, infertility has become a social concern and has associated with numerous problems. Social support as a protective factor can have a significant effect on the health and social functioning of infertile women. The aim of this study was to assess perceived social support and its related factors in infertile women referred to the Shahrekord Infertility Clinic in 2018. Methods: In the descriptive cross-sectional study, 400 infertile women (18-49years) referred to Shahrekord Infertility Clinic with primary and secondary infertility were enrolled on the basis of objective sampling. Demographic characteristics of infertile women were recorded and social support was determined by Social Support Questionnaire (SSQ) of Sarason. Data were analyzed using SPSS software and P <0. 05 was considered statistically significant. Results: The results of the study showed that the mean total score of social support, network of social support and satisfaction of social support of infertile women were 150. 22 ± 50. 09, 32. 99 ± 16. 36, and 117. 97 ± 38. 5 respectively. The highest frequency of social support was for mother (51. 6%), father (40. 7%) and spouse (29. 5%). Social support scores had a direct and significant relationship with the marriage age of infertile women spouses (r = 0. 151 and P = 0. 002), so Social support increased as the marriage age increased. Social support of satisfaction dimension was not significantly correlated with the age of women and their spouses, as well as the age of marriage of women and their spouses. Social support of network dimension has a significant relationship with the marriage age of infertile women (r = 0. 173 and P < 0. 001), the age of infertile women spouses (r = 0. 180 and P < 0. 001) and the marriage age of infertile women spouses (r = 0. 265 and P < 0. 001). Conclusion: The results of the study indicate that the age and marriage age affect social support, especially from the network dimension, so that with the increase of age and marriage age, the social support of infertile women increased.

Background & Aims: Blindness is one of the disabilities that has a major impact on the individual’ s ability to function in everyday life and has psychological, emotional, cognitive, and social consequences. Self-care education in the blind kids can be effective in improving children’ s mental and social status. Therefore, the aim of this study is to investigate the effect of Orem’ s self-care education on physical self-concept and socio-social isolation. Methods: A single-group interventional study with pre-and post-test design was conducted on 28 blind children at Samani Blind School in Isfahan in 2018. The Orem self-care curriculum was presented in a 6 sections (each section 60 minutes) in 4 group 7-person with lecture and question-and-answer method. Then, self-concept and social isolation of these children were assessed using Pierce-Harris questionnaires Usher was assessed and recorded before and immediately after the intervention. Finally, data were analyzed by SPSS software using Wilcoxon test and simple linear regression. Results: The results showed that none of the dimensions of physical self-concept and social isolation of children after Orem self-care education had a significant change compared to the previous one. None of the factors studied such as age, child gender or parental baseline information had significant effect on the rate of these children changing of physical self-concept and the social isolation. Conclusion: Although Orem’ s self-care education causes changes in the mean score of body self-concept and social isolation in blinded children but this change is not significant. In addition, it seems that by increasing the time for educational intervention, better results can be obtained.

Background & Aims: VAP prevention is a top priority in the intensive care units. The study was conducted to compare the effect of using normal saline and distilled water for tracheal suctioning on the incidence of ventilator-associated pneumonia and hemodynamic indexes in ventilator-dependent patients. Methods: The present study is a randomized clinical trial that was conducted from 2017 to 2018 on 60 ventilator-dependent patients in the ICUs of Jafar Sadeg Hospital affiliated to Alborz University of Medical Sciences. Patients were allocated to the two intervention and control groups by block random allocation method. The hemodynamic parameters of patients (respiratory rate, heart rate, blood pressure, and SPO2) were recorded in a form 5 minutes before and after the suctioning in each Shift. Finally, the incidence of VAP and changes in hemodynamic indexes in the two groups were compared. Results: The two groups did not differ from each other significantly (P = 0. 79) in terms of tracheal culture and incidence of VAP. The results showed that intra-group hemodynamic indexes (heart rate, blood pressure, respiratory rate and SPO2) did not differ significantly before and after the suctioning in normal saline and distilled water groups. The inter-group test showed that, the two groups only had a significant difference in the level of arterial oxygen saturation after the intervention (p = 0. 006). Conclusion: As the level of SPO2 was higher in the normal saline group, it is better to use normal saline as a diluent for pulmonary secretions before tracheal suctioning.

Background & Aims: Open ICU visiting is recommended because of positive effects on patients and relatives. However, patient visiting in Iranian’ s ICU is restricted now. Many issues around the subject have not been properly addressed. Here the visiting challenges have been discussed. Methods: This is a qualitative descriptive-exploratory study conducted through semi-structured deep interview with 35 participants (6 patients, 20 nurses, and 9 patient relatives) in Shahrekord in 2017. Data analysis was carried out with a thematic analysis approach. Results: The main emerged theme was the “ Conflict Experience” . Families (patients’ relatives) and patients consider the visiting as an important and necessary need, and this unmet need causes “ imbalance between the families’ need and laws” and the “ imbalance between the patient’ s need and the laws. ” Meanwhile, there was another dichotomy that was imbalance between “ nurses’ human and scientific beliefs on the patients and families’ need” and “ nurse’ s belief in the reasons for the forbidden visiting and laws” . Conclusion: Experiencing “ conflict” in participants indicates the necessity to find scientific and applicable strategies to address the visiting challenge.