Routine Hospital Care Research Articles

MOTIVATIONAL INTERVIEWING TO ENGAGE OLDER INPATIENTS IN FALL PREVENTION: PILOT RANDOMIZED CONTROLLED TRIAL

Motivational Interviewing (MI) is an evidence-based approach for fostering behavior change and holds potential to engage patients in behavior change related to fall prevention. A two-arm, unblinded, pilot randomized controlled trial was conducted in a hospital setting to determine the feasibility (recruitment and retention), establish suitable procedures for the intervention (duration and quality of MI), and to test study measurements (fear of falling, importance and confidence related to fall prevention, patient activation, fall prevention behaviors, and fall rates). Participants were high fall risk older inpatients (age ≥ 65). The intervention arm received MI at one time during hospitalization in addition to routine hospital fall prevention intervention. The control arm received the routine hospital care for fall prevention only. Measures were collected at baseline, 2-days, 1-week, 1-month, and 3-month. A total of 120 inpatients were contacted by the study team and 67 were randomized: intervention arm (n=36) and control arm (n=31). Approximately 66% of participants completed the study at the 3-month data collection and MI intervention took an average of 21 minutes and was of adequate quality. The intervention group reported less fear of falling after the MI intervention and maintained fall prevention behaviors over time (p<.05). The study identified that MI for fall prevention at a hospital setting was feasible to deliver and provided insights into suitable study procedures and beginning evidence for a positive impact of MI.

Effect of Implementation of Health Educational Guidelines on Maternal and Neonatal Outcomes among Women with Gestational Diabetes Mellitus

Abstract: Diabetes Mellitus (DM) is one of the most common medical complication that often affects pregnancy. Diabetes in pregnancy may be gestational (90%) or pregestational (10%) when it antedates pregnancy. Gestational Diabetes Mellitus (GDM) can lead to range of adverse pregnancy outcomes including; serious short and long-term maternal, fetal, as well as neonatal complications. Effective management with health educational intervention regarding GDM risks and its proper self-care measures will contribute to complications reduction and improve pregnancy outcomes for the woman and her offsprings. The aim of this study: was to evaluate the effect of implementation of health educational guidelines on maternal and neonatal outcomes among women with gestational diabetes mellitus. Subjects and method: The study was conducted at antenatal units of obstetric department at three settings; Tanta University Hospital, El-Menshawy General Hospital and El-Mabara Hospital. A convenient sample of 50 pregnant women diagnosed with GDM selected from the previously mentioned settings fulfilling the inclusive criteria were included in the study. Four tools were used for data collection: Tool I: A structured interview schedule that included (a). Socio-demographic characteristics, (b). Reproductive history, and (c). History of present pregnancy. Tool II: Anthropometric measurements, collected data about body mass index (BMI) of pregnant women. Tool III: Structured GDM Women's Knowledge Interview Schedule, included data related to Part a: assessment of women's knowledge about GDM and Part b: assessment of women's actual self-care measures regarding GDM. Tool IV: Outcome Assessment Tool: that included two parts Part I: Maternal outcome assessment sheet and Part II: Neonatal outcome assessment sheet. Results: The results of the present study revealed that fair and good level of knowledge as well as satisfactory level of self-care measures about GDM was reported among the study group after implementation of the education sessions. As well as significant improvement of maternal and neonatal outcomes were revealed among women of the study group who were less likely to develop maternal and neonatal complications after the implementation of the health education sessions in relation to time of onset labor, labor complications, length of hospital stay, neonatal complications, apgar score, birth weight, and also gestational age at delivery, as well as admission to neonatal intensive care unit. Conclusion: Health educational guidelines provided to the study group had improved their level of knowledge, awareness as well as self-care measures regarding GDM which consequently reflect positive effect on the maternal and neonatal outcomes in comparison with the control group who received only the routine hospital care. Therefore, the study recommended: Planning and developing antenatal health educational classes for all women to increase their awareness about the importance of early antenatal proper screening and effective GDM management to improve their pregnancy outcomes. Inaddition, refreshing courses and in-service training programs especially for newly appointed nurses can be successful in improving their knowledge and practices regarding GDM..

Effect of Cardiac Rehabilitation on Sexual Satisfaction Among Patients After Coronary Artery Bypass Graft Surgery.

After coronary artery bypass graft (CABG) surgery, many patients experience diminished sexual function and satisfaction. The present study aimed to investigate the effect of outpatient cardiac rehabilitation (OCR) on the level of sexual satisfaction among post-CABG patients. A clinical trial was performed at the Al-Zahra Hospital, Shiraz, Iran, from July 2017 to January 2018. Based on the inclusion criteria, 104 post-CABG patients were recruited into the study. The participants were randomly assigned to the intervention (OCR) group (n = 52) or the usual care group (n = 52). The intervention group received 20 sessions of OCR, whereas the usual care group received the routine hospital care and education. Data were collected using the Index of Sexual Satisfaction and a demographic data sheet. The data were analyzed using the SPSS software, v23.0 (IBM) and the independent sample t test, paired-samples t test, and χ test. There was no statistically significant difference in the mean pre-intervention score for sexual satisfaction between the groups. However, a statistically significant difference in the mean post-intervention score for sexual satisfaction was observed between the groups (P < .001). The difference in the mean pre- and post-intervention scores for sexual satisfaction in the intervention group was statistically significant (P < .001), whereas there was no significant difference in the usual care group. Post-CABG patients who completed the OCR program experienced an increased level of sexual satisfaction. It is, therefore, recommended to include an OCR program as part of the patient treatment and aftercare following CABG surgery.

Effect of Early Maternal and Newborn Skin to Skin Contact after Birth on the Duration of Third Stage of Labor and Initiation of Breastfeeding

Background: - Early skin to skin contact between mother and newborn after labor makes an ideal environment for the adaptation of the newborn to extra uterine life. This simple procedure is recommended as an important enhancement in care directly after delivery. The aim of this study: was to evaluate the effect of early maternal and newborn skin to skin contact after birth on the duration of third stage of labor and initiation of breastfeeding. Subjects and Method: The study was conducted at Tanta University and El- Menshawy hospitals. A convenient sample of 100 parturient women was recruited. The study included a study group (50) who considered skin to skin contact and a control group (50) who received routine hospital care. Five tools were used for the collection of data: Tool (I): A structure interview schedule included the basic data related to a. socio demographic characteristics, b. Reproductive history. Tool (II): Assessment of the third stage of labor. Tool (III): Mother’s breastfeeding knowledge Assessment tool. Tool (IV): Breastfeeding Assessment Tool: It included three parts: Part a: The Infant Breastfeeding Assessment Tool (IBFAT), Part b: Assessment of initial breastfeeding outcome, Part c: Assessment of successful latch on. Tool (V): Exclusive breastfeeding: Follow- up assessment tool. The results of the present study shown that the skin to skin contact group had well contracted uterus, less need for uterotonic drugs and no uterine atony or excessive blood loss have been recorded compared to the control group. Accordingly, the mean duration of third stage of labor was shorter (6.48 ± 1.25) among the skin to skin contact group than among the control group (14.87± 3.88). It also revealed that success in first breastfeeding was higher among study group compared to control group. Conclusion and Recommendation: The study concluded that there is a positive effect of early maternal newborn skin to skin contact after birth on the duration of third stage of labor and initiation of breastfeeding.Therefore, it is recommended that refreshing courses, pre-service and in-service training programs especially for newly appointed nurses working in the delivery room about the implementation of skin to skin contact technique for all mothers and newborns.

Effectiveness of salt water application on episiotomy wound among postnatal mothers

Pregnancies, as a whole, has extended and widen changes for an antenatal mother. Maternal schemes play an important role in mother, baby and family during the antenatal period. 60 (30 experimental groups and 30 control group) patients (postnatal mothers) who met the inclusion criteria were selected by using non-probability convenience sampling technique. After selecting the sample, the investigator explained the purpose of the study and informed consent was obtained. Demographic variables were collected pre-test was done by using the REEDA scale (experimental and control group). For the experimental group, the saltwater application was given twice a day for five days in 8 hours. Control group receives the routine hospital care. On the third postnatal day, post-test was done for the experimental and control group. The data were tabulated and analysed by descriptive and inferential statistics. The result shows that in experimental group pre-test (3.33%) were mild healed, and 29(97%) were not healed and in control group 30(100%) were not healed. post-test in experimental group 22(73%) were healed, and 8(27%) were moderately healed, in the control group 2(7%) were healed, 15(50%) were moderately healed and 13(43%) were mild healed. The calculated‘t' value is significant at P&lt; 0.005. The study indicates that the application of salt water is effective on episiotomy wound healing among postnatal mothers.

Application of vision combined with olfactory stimulation nursing in patients with laparoscopic cholecystectomy on the body recovery and pain

Objective To explore the effect of visual and olfactory stimulation nursing on the recovery and pain of patients undergoing laparoscopic cholecystectomy. Methods A total of 69 cases of patients with laparoscopic cholecystectomy receiving routine care in this hospital from November 2015 to November 2016 were selected as the control group. In addition, 69 cases of laparoscopic cholecystectomy patients admitted by the hospital from December 2016 to December 2017 for visual and olfactory stimulation nursing were selected as the observation group. The changes of daily living ability and pain degree were compared between the two groups. Results The time of first exhaust, time of getting out of bed, time of normal eating and time of hospitalization in the observation group were shorter than those in the control group, and the differences were statistically significant(P<0.05). ADL scores in the observation group were all higher than those in the control group after 3 days of nursing, and the difference was statistically significant(P<0.05). NRS scores in the observation group were lower than those in the control group after 3 days of nursing, and the difference was statistically significant(P<0.05). Conclusion The application of vision and smell stimulation nursing in patients with laparoscopic cholecystectomy can effectively promote the recovery of the body, improve living ability, reduce pain, is worthy of clinical promotion. Key words: Visual stimulation; Olfactory stimuli; Nursing; Laparoscopic cholecystectomy; Body recovery

Comparison of the Effects of Islamic Spiritual Educations and Breathing Techniques with Heart Rate Variability Feedback Therapies on Heart Rate Variability, Psychophysiological Coordination and Stress in Patients Undergoing Coronary Artery Bypass Graft Surgery

Background: Patients with coronary artery disease also have psychological disorders, such as stress and depression, especially if they underwent coronary artery bypass graft (CABG) surgery; a type of bypass surgery that forms new routes around narrowed and blocked coronary arteries, permitting increased blood flow to deliver oxygen and nutrients to the heart muscle. Objectives: The current study aimed at comparing the effect of Islamic educations and breathing techniques with heart rate variability (HRV) biofeedback therapies on HRV, psychophysiological coordination, and stress in patients undergoing CABG. Methods: A total of 60 patients who underwent CABG surgery were selected and randomly assigned to three equal groups of the Islamic educations, breathing techniques, and control. The experimental groups received an eight-week intervention as a two-hour session per week with home practices. The control group received only the routine hospital care. The stress, HRV, and psychophysiological coordination levels of the subjects were evaluated before and after the interventions in the three groups using depression, anxiety, and stress scale-21 for stress and emWave Desktop software for HRV and psychophysiological coordination. The data were analyzed using ANCOVA and descriptive tests with SPSS version 21. Results: The results showed a significant difference among the three groups in the increase of HRV and psychophysiological coordination and decrease of stress. Moreover, stress level reduced more in the Islamic educations group, while HRV and psychophysiological coordination levels increased more in the breathing techniques group. Conclusions: Based on the results, it is recommended using both Islamic educations and breathing techniques as well as HRV biofeedback therapies in rehabilitation programs for patients undergoing CABG in hospitals.

951-P: A Clinical Decision Support System for Basal-Bolus Insulin Therapy Is Moving to Hospital Routine Care: Efficacy, Safety, and Usability Confirmed

Glycemic goals of inpatients should consider the prevention of hypoglycemia and hyperglycemia. To achieve glycemic control in the hospital, guidelines recommend basal-bolus insulin therapy as the preferred method for treatment of persistent hyperglycemia and the use of clinical decision support systems. The aim of this study was to investigate the efficacy, safety and usability of the GlucoTab® decision support system in hospital routine care of non-critically ill patients with type 2 diabetes at 3 general wards of a university medical center. In total, 150 patients with type 2 diabetes requiring insulin therapy (56 female, age 68 ± 11 years, HbA1c 77 ± 24 mmol/mol, diabetes duration 15 ± 11 years, BMI 30 ± 6 kg/m2, length of hospital stay 9 ± 7 days) were treated with basal-bolus insulin therapy guided by GlucoTab®, a mobile decision support system providing automated workflow tasks and suggestions for insulin dosing to nurses and physicians. In total 4879 capillary blood glucose values (BG) were documented. By using the GlucoTab® system in routine care, a mean daily BG of 159 ± 32 mg/dl could be achieved. 68.8% of all BG measurements were in the acceptable range (70-&amp;lt;180 mg/dl). The percentage of BG values &amp;lt;40, &amp;lt;70 and ≥300 mg/dl was 0.02%, 2.2% and 2.3%, respectively. Health care professional’s adherence to the suggested insulin doses (n=7407) and workflow tasks (n=9927) was high (&amp;gt;93% and 91%, respectively). The study confirmed that the GlucoTab® system supports a safe, efficacious and user-friendly glycemic management of basal-bolus insulin therapy in hospital routine care. Further research will include decision support for alternative therapy types for patients with less stringent goals to prevent hypoglycemia in hospital routine care. Disclosure K.M. Lichtenegger: None. F. Aberer: None. A.C. Tuca: None. K. Donsa: Stock/Shareholder; Self; decide Clinical Software GmbH. B. Höll: Employee; Self; decide Clinical Software GmbH. L. Schaupp: None. J. Plank: None. P. Beck: Employee; Self; decide Clinical Software GmbH. Stock/Shareholder; Self; decide Clinical Software GmbH. F. Fruhwald: None. T.R. Pieber: Advisory Panel; Self; ADOCIA, Arecor Limited, AstraZeneca, Novo Nordisk A/S, Sanofi. Speaker's Bureau; Self; Novo Nordisk A/S. J.K. Mader: Advisory Panel; Self; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Prediktor Medical, Roche Diabetes Care, Sanofi. Speaker's Bureau; Self; Abbott, AstraZeneca, Dexcom, Inc., Novo Nordisk Inc. Stock/Shareholder; Self; decide Clinical Software GmbH. Funding Research Studio Austria "GlucoTab“ (844737)

Effect of Story-Telling on Reducing the Intensity of Nausea and Vomiting among Children Undergoing Chemotherapy

The study aimed to assess the effect of storytelling on reducing intensity of nausea and vomiting in children undergoing chemotherapy. Design: Quasi-experimental research design was used in the study. Subjects: 200 children were equally and randomly assigned into two groups, the first was the control group, the second was story telling group, their age ranged from 3-6. Setting: the study conduct years at Oncology institute at Sohag City and Sohag university hospital. Tools: an Interview Structured Questionnaire was developed by the researcher and Rhodes Index of Nausea and Vomiting Likert scale was utilized for collecting the data. Results: statistically significant difference was detected among the studied children as regards the occurrence frequency of nausea per 24 hours with mean ± SD (1.63 ± 1.22 after the intervention compared to 3. 63 ± 2.88 before the intervention. A statistically significant difference was detected between the two groups as regards of vomiting before and after the intervention. Conclusion: children who exposed to story - telling experienced lower intensity of nausea and vomiting compared to children in the control group who received routine hospital care. Recommendations: They should include telling story and parents' education about non pharmacological management for nausea and vomiting.

Invasive Fungal Infection.

The incidence of invasive fungal infection is approximately 6 cases per 100 000 persons per year. It is estimated that only half of such infections are detected during the patient's lifetime, making this one of the more common overlooked causes of death in intensive-care patients. The low detection rate is due in part to the complexity of the diagnostic work-up, in which the clinical, radiological, and microbiological findings must be considered. Fungi with resistance to antimycotic drugs have been found to be on the rise around the world. This review is based on pertinent publications retrieved from a selective search in PubMed, with special attention to guidelines on the diagnosis and treatment of invasive fungal infections caused by Candida spp., Aspergillus spp., Mucorales, and Fusarium spp. The clinical risk factors for invasive fungal infection include, among others, congenital immune deficiency, protracted (>10 days) marked granulocytopenia (<0.5 x 109/L), allogeneic stem-cell transplantation, and treatment with immunosuppressive drugs or corticosteroids. High-risk groups include patients in intensive care and those with structural pulmonary disease and/or compli- cated influenza. The first line of treatment, supported by the findings of randomized clinical trials, consists of echinocandins for in- fections with Candida spp. (candidemia response rates: 75.6% for anidulafungin vs. 60.2% for fluconazole) and azole antimycotic drugs for infections with Aspergillus spp. (response rates: 52.8% for voriconazole vs. 31.6% for conventional amphotericin B). The recommended first-line treatment also depends on the local epidemiology. This challenge should be met by interdisciplinary collaboration. Therapeutic decision-making should also take account of the often severe undesired effects of antimycotic drugs (including impairment of hepatic and/or renal function) and the numerous interactions that some of them have with other drugs. Invasive fungal infections are often overlooked in routine hospital care. They should be incorporated into antimicro- bial stewardship programs as an essential component. There is also a pressing need for the development of new classes of antimycotic drug.

Effect of Implementing Total Parenteral Nutrition Nursing Guidelines on Adult Critically Ill Patients’ Outcomes

Total parenteral nutrition for hospitalized critically ill patients is essential for improving outcomes, insufficient nutritional support lead to occurrences of complications, increased morbidity and mortality rates, increased length of hospital stay. Critical care nurses are the cornerstone in preventing theses complications. Aim: To investigate the effect of implementing total parenteral nutrition nursing guidelines on adult critically ill patients’ outcomes. Design: Non randomized prospective research design was used to utilize this study Subjects: convenience samples of 60 patients were assigned equally to study and control group at intensive care units at Assiut University hospitals. The control group received routine hospital care during TPN administration while, the study group received the developed guidelines for TPN during a period from January 2018 to December 2018. Methods Each patient in both groups were assessed by taking history, clinical examination, nutritional assessment laboratory investigation. Patients in study groups were received care according to developed total parenteral nutrition guidelines to determine outcome and complications in both groups. Results Finding of the present study revealed that significant improvement in study group with values of less than p=001 compared to control group Conclusion : implementing of total parenteral nutrition guidelines improve the outcomes and reduce the occurrence of complications among critically ill patients. Keywords : total parenteral nutrition, nursing guidelines, critically ill patient, outcomes DOI : 10.7176/JHMN/61-04 Publication date : April 30 th 2019

Impact of Educational Intervention on Reducing Postpartum Sleeping Pattern Alterations

Background: Most women (78%) reported their sleep quality to be worse during the childbearing period than in any other time of their lives. Postpartum sleep disturbances are caused by the natural physiological alterations that follow childbirth. Aim: Is to assess the sleeping quality index among postpartum mothers and to determine the impact of educational intervention on improvement of postpartum sleeping pattern alterations. Design: Randomized control trial design. Sample: Consisted of (550) women immediately after delivery and divided into two main groups 275 for each. Study group received educational intervention booklet about good sleeping pattern and followed at 15th day and after 42nd day postpartum at Al Azhar Assiut University Hospital. The second group received the routine hospital care. Tools: Socio demographic data, the current delivery outcomes and Pittsburgh Sleep Quality Index, 2016 questionnaire. Results: About two thirds (65.8%) of the study group had moderate sleep quality Vs. (69.8%) of the control group with no statistical significant difference between both groups immediately after delivery. While there are highly statistical significant difference between both groups after 15th days and after 42nd days postpartum (P=0.000), for sleep quality items. Conclusion: Maternal sleep quality improved after 15 day and 42 day postpartum after implementing sleeping educational intervention. Recommendations: Further efforts are needed through educational intervention programs by nurses to improve maternal sleeping quality during pregnancy and the postpartum period.

Effect of Shaker Exercises on Swallowing Disturbance among Patients with Hyperthyroidism at a Selected University Hospital

Background: Apparently; the most common causes of hyperthyroidism represent in Graves’ disease. Shaker Exercises implementation through head lift exercise and tongue strengthening exercises aim to improve motility and strength the muscles of the neck and enhance swallowing capabilities as well. Aim of the current study was to examine the effect of shaker exercises on swallowing disturbance among patients with hyperthyroidism at a selected University Hospital, Egypt. Design: A quazi-experimental design time series Non-equivalent design was utilized, the study conducted at surgical departments at one of University Hospital; Egypt. Research hypothesis: H1: Study group who received the Shaker Exercises will have a significant lower mean swallowing disturbance score than the control group who received only routine hospital care. H2 (a,b,c & d): Study group who received the Shaker Exercises will have higher correlation between total swallowing disturbance score and selected related sub-Items than the control group who received only routine hospital care. Sample: 60 adult male and female patients divided randomly into two equal groups, control group (n=30 patients) received the routine hospital of the hyperthyroidism, and study group (n=30 patients) received routine hospital in addition to the Shaker Exercises. Tools: Tool I: Demographic and medical data sheet. Tool II: Swallowing Disturbance Questionnaire (SDQ). Results: there was a statistical significant difference among study group comparing to control group regarding the swallowing disturbance after shaker exercise interventions. Conclusion: study group patients who received the Shaker Exercise in addition to their routine hospital care which was medical treatment was improved significantly comparing to the control group who received only their medical treatment. Recommendation: Replicate the study on a larger group to add to solid evidence practice and replicate the study on other disease rather than hyperthyroidism that interfere with swallowing function.

Role of sucrose, pacifier and their combination as pain reliever among preterm neonates during painful procedures

Background/Objective: The role of sucrose and/or non-nutritive sucking (NNS) has been evaluated for relieving procedural pain in newborn infants with satisfactory results however there was a controversy regarding the synergestic effect of their combination.}Methods: This quasi-experimental study was conducted in the neonatal intensive care unit in Assiut University Children Hospital including 120 preterm neonates who were divided into 4 groups (20 neonates each). Control group received routine hospital care; sucrose group received oral sucrose solution (OS); pacifier group received pacifier; and last group received oral sucrose solution and pacifier during painful procedures. All were assessed regarding socio-demographic and clinical data in addition to application of Premature Infant Pain Profile (PIPP) scale to assess the levels of pain and mean pain scores pre and post-intervention.Results: The 4 groups were similar regarding soci-demographic and clinical data. The application of the OS and/or pacifier, led to significant improvement of the levels of pain and reduction of the mean score of pain among preterm neonates during painful procedures. In addition, combined pacifier and OS was superior to OS alone and comparable to pacifier alone regarding their effect on the reduction of pain level and mean score of pain.Conclusions: OS and pacifier are effective as pain reliever during painful procedures among preterm neonates. Combined OS and pacifier is superior to OS and pacifier alone.

Using chamomile for alleviating oral mucositis among patients with head and neck cancer receiving radiotherapy

Background Radiotherapy-induced oral mucositis remains one of the main and most common adverse effects affecting all patients receiving radiotherapy for head and neck cancer (HNC). Aim To evaluate the use of chamomile on alleviating oral mucositis among patients with HNC receiving radiotherapy. Design A quasi-experimental nonequivalent control group interrupted time series design was utilized. Research hypotheses H1: patients who receive chamomile gel will have a statistically significant difference regarding oral mucositis grade compared with the control group who receive only routine hospital care. H2: patients who receive chamomile gel will have statistically significant lower mean severity scores of pain intensity associated with oral mucositis compared with those who receive only routine hospital care. H3: patients who receive chamomile gel will have statistically significant lower mean severity scores of patient-reported oral mucositis symptoms compared with those who receive only routine hospital care. Sample A convenient sample of 60 patients with HNC was recruited along 6 months. Tools Four tools were used to collect data: Structured Interview Questionnaire, National Cancer Institute Scoring for Mucositis, Patient-Reported Oral Mucositis Symptoms Scale, and Pain Numeric Rating Scale-11. Results In spite of the increase in oral mucositis grade among the study and the control groups, there was a statistically significant difference between both groups, and the increase in oral mucositis grade in the study group was significantly less than the control group. Moreover, there was a statistically significant difference in pain severity mean scores, as well as patient-reported oral mucositis symptom mean scores in favor of the study group that received chamomile gel compared with the control group that received only routine hospital care. Conclusion Chamomile gel was effective in reducing oral mucositis grade, severity of pain, as well as patient-reported oral mucositis symptoms in the study group compared with the control group.

A Nurse-Led Care Program for Breast Cancer Patients in a Chemotherapy Day Center: A Randomized Controlled Trial.

Healthcare providers are facing the challenge of helping cancer patients cope with the impact of outpatient-based chemotherapy. A nurse-led care program was proposed to address this challenge. The aim of this study was to examine the effects of a nurse-led care program for patients receiving outpatient-based chemotherapy. This was a single-center, open-label, 2-arm parallel trial with equal randomization (NCT02228200). Breast cancer patients in Hong Kong were randomly allocated to the intervention arm or the control arm. The control arm received routine hospital care. The intervention arm received the nurse-led care plus the routine hospital care. The quality of life, self-efficacy, symptom distress levels, and satisfaction with care were evaluated with questionnaires before randomization (T0), in the middle of chemotherapy (T1), and 1 month after chemotherapy (T2). Individual interviews were conducted with some participants in the intervention arm at T2. The intervention arm participants reported significantly lower distress levels from oral problems, fatigue, peripheral neuropathy, distressful feelings, and higher satisfaction with care. According to the satisfaction evaluation and the interviews, the participants stated that the service was helpful in providing information and communication opportunities, filling the service gap after drug administration, providing psychological support, relieving discomfort, and building confidence. Breast cancer patients received support from the provision of comprehensive, continuous, and individualized care. The nurse-led care program could be applied to breast cancer patients in other hospitals in Hong Kong. Exploring its applicability to cancer settings in other countries is recommended.

Effect of Text Messaging-based Psychiatric Nursing Program on Quality of Life in Veterans with Post-Traumatic Stress Disorder: A Randomized Controlled Trial

ABSTRACTBackground:Recurrent post-traumatic stress disorder (PTSD) can devastate the life of a veteran. Despite the widespread use of mobile learning technology in health care and nursing, few studies have examined its potential in PTSD patients and the effect on quality of life (QoL). The present study aimed to investigate the effect of a text messaging-based psychiatric nursing program on QoL in veterans with PTSD symptoms. Methods:A single-blinded, randomized, controlled trial was conducted at the outpatient clinic of Sadr Hospital in Tehran (Iran) from January 2014 to October 2015. A total of 98 veterans with PTSD who referred to the outpatient clinic of the hospital were initially assessed for eligibility to participate in the study. Based on the inclusion criteria, 66 veterans were recruited in the study and randomly allocated to a control group (n=33) and an intervention group (n=33). Due to the lost to follow-up, 9 participants (control=4, intervention=5) were excluded from the analysis phase. The intervention group received psychiatric support via short text messages for 6 months, whereas the control group received the routine hospital care. The self-rating scale for PTSD (SRS-PTSD) and the short form 36 (SF-36) were used to evaluate the severity of symptoms and the QoL, respectively. The results were analyzed using the SPSS software (version 18.0) with the Chi-square test, Fisher’s exact test, independent sample t test, and paired sample t test. P<0.05 was considered statistically significant. Results: A significant improvement in PTSD (P=0.001) and QoL (P=0.001) was observed in the intervention group compared to the control group. Moreover, the recurrence frequency in the intervention group was significantly lower (P=0.03). Conclusion:The text messaging-based psychiatric nursing program reduced the severity of symptoms in veterans with PTSD and improved their QoL. Trial Registration Number: IRCT2013101214983N1

Effect of applying saline spray on nasal health status of critically ill patients

Objective: A fundamental aspect of hygienic care in ICU is nasal care. However, providing nasal care for critically ill patients is challenging because of caring for very sick patients in a highly stressful environment results in nasal care having a lower priority for nurses than other aspects of care. This study was conducted to investigate the effect of applying saline spray on nasal health status of critically ill patients.Methods: This study was carried out in intensive care units at Emergency Hospital. Sixty patients were enrolled and divided into a study group who received saline nasal spray three times daily for seven days and a control group who received routine hospital care. Secretion load and nasal cultures were assessed before and on the 7th day of nasal care.Results: No significance difference was found between control and study groups as regards to secretion score before nasal care. On the 7th day, there was a statistically significant deterioration of the secretion score by increasing to 3 (p &lt; .001) in the control group. However, a significant improvement was noted in the study group in comparison to the control group (p &lt; .001). In addition, about half of the control group had proliferated Klebsiella in the first culture which continued to the second culture on the 7th day of routine nasal care while no one had proliferated Klebsiella in the studied sample following administration of normal saline spray which was highly statistically significant. Conclusions: The use of saline nasal spray is more effective than routine nasal care in reducing colonization with different bacterial species and improving secretion score.

The Implementation of a Discharge Planning to Improve Quality of Life in Breast Cancer Patients: A Quasi-Experimental Study

Background: Breast surgery for women newly diagnosed with breast cancer is associated with poor postoperative quality of life (QOL). The aim of this study was to determine the effectiveness of a programmed discharge planning in improving overall QOL and its physical, emotional, social, and spiritual domains.&#x0D; Method: In this quasi-experimental study, we evaluated the newly diagnosed breast cancer women undergoing breast-conserving therapy in two groups, an experimental group (n = 35) and a control group (n = 34). The experimental group received programmed discharge planning at the time of hospital admission until six weeks after discharge. The control group received routine hospital care. Participants completed the QOL questionnaires before and after the intervention. The data were analyzed using the independent-samples t test, Fisher exact test, and Mann-Whitney U.&#x0D; Results: Before the intervention, there were no significant differences between the control and experimental groups in overall QOL or its physical, emotional, social, and spiritual domains. The data analysis after intervention showed significant improvement in QOL in the experimental group as compared with the control group. The changes in the scores of various domains of QOL were statistically significant (P &lt; 0.01).&#x0D; Conclusion: This study emphasizes that programmed discharge planning is useful for improving QOL after breast-conserving surgery. Our finding could be applied to breast cancer patients with radiation therapy or chemotherapy.

Effect of implementing designed educational training program for neurological nurses on clinical outcomes of stroke patients

Background: Stroke is a major cause of functional disability, it increased the need for continuous nursing care. Nurses need to pay attention not only to the physical recovery after stroke, but also to the psychological and social recovery. Therefore, it is important to provide training courses to nurses about care of stroke patients.Aim: This study was conducted to evaluate the effect of implementing designed educational training program for neurological nurses on clinical outcomes of stroke patients.Methods: Design: A quasi experimental research design was utilized. Setting: Data were collected from Neurological Intensive Care Units, Wards and Neurological outpatient clinics of Tanta Main University Hospital. Sample: All nurses (n = 35) who are providing direct care for stroke patients and a purposive sample of 30 stroke patients. Tools: Three tools were used to collect data. Tool (I): Assessment of nurses’ knowledge questionnaire sheet about stroke; Tool (II): Observational checklist to evaluate nurses’ practice regarding care of stroke patients; and Tool (III): Patient’s clinical outcomes assessment sheet.Results: The results revealed that there were significant improvements in nurses’ knowledge and practice regarding care of stroke patients post training program at p &lt; .01. Also, significant improvements in self-care and activities of daily living among stroke patients were observed from immediately to 2 months later post application of training program.Conclusions: The study findings revealed that the implementation of designed educational training program within 2 months were successful for improving nurses’ knowledge and practice regarding care of stroke patients. Furthermore, there was improvement in activities of daily living and self-care among stroke patients.Recommendations: It is recommended to generalize implementation of designed educational training program for neurological nurses as a routine hospital care for stroke patients.