Effect of Home-based Pulmonary Rehabilitation on Fatigue, Dyspnea, and Activities of Daily Living of COVID-19 Patients

Background: The acute nature and complications of COVID-19, including fatigue and dyspnea, reduce the ability of the affected individuals to play individual and social roles and perform activities of daily living, and have adverse effects on the life quality and economic status of patients. Conducting pre-discharge rehabilitation programs following a home-based approach can be effective in reducing fatigue and dyspnea and improving the activities of daily living of COVID-19 patients. Objectives: This study aimed to investigate the effect of home-based pulmonary rehabilitation on fatigue, dyspnea, and activities of daily living of COVID-19 patients in the teaching hospitals of Zahedan University of Medical Sciences in 2020. Methods: The quasi-experimental study enrolled 60 patients with COVID-19 respiratory symptoms admitted to the COVID-19 intensive care units of teaching hospitals affiliated with Zahedan University of Medical Sciences in 2020. The patients who met the inclusion criteria were selected using convenience sampling and randomly divided into intervention and control groups with color cards. The instruments used to collect the data were the Fatigue Severity Scale (FSS), the Borg Dyspnea Scale, and the Barthel Index completed by the participants before, two weeks, and two months after the intervention. The rehabilitation training was provided to the patient and the primary caregiver in the intervention group in three 45-min sessions individually and using training videos during the hospital stay. After discharge, the patients were followed up in person or by phone for eight weeks to ensure the effectiveness of the rehabilitation program. The collected data were analyzed using SPSS-22 software through repeated measures analysis of variance (ANOVA), independent samples t-test, and chi-square test at a significance level of 0.05 (P < 0.05). Results: The repeated measures ANOVA showed that changes in the fatigue and dyspnea scores were significant over time (P < 0.001). Furthermore, the intervention effect was significant (P = 0.04), and more remarkable changes were observed in the intervention group than in the control group. Given the significance of the group-time interactive effect on the two given variables, the comparisons were made point by point and with Bonferroni correction again by time and group. There were significant differences in the mean fatigue scores in the second (P = 0.03) and third (P < 0.001) stages and the mean dyspnea scores (P < 0.001) between the two groups. The mean scores of activities of daily living two weeks and two months after the intervention were significantly different between the two groups, with higher scores in the intervention group than in the control group (P = 0.01). The repeated measures ANOVA confirmed a statistically significant difference between the two groups in terms of the effect of time (P < 0.001) and group (P = 0.03) on the patients’ activities of daily living. Conclusions: The study showed that home-based pulmonary rehabilitation measures were effective on fatigue, dyspnea, and activities of daily living of COVID-19 patients. Thus, this intervention approach by nurses for family participation can be practical for treating acute and chronic respiratory diseases.

Effect of Local Cold Therapy on Arterial Blood Oxygen Saturation and Temperature Changes in Patients Undergoing Surgery

Background: Postoperative complications can endanger the patient's life and disrupt the recovery process if not properly managed. Local cold therapy can be a safe non-pharmacologic method to manage these side effects; however, it has not been highly considered. Objectives: This study was done to determine the effect of local cold therapy on arterial blood oxygen saturation and temperature changes in patients undergoing surgery. Methods: This quasi-experimental study was performed at Shahrekord University of Medical Sciences in 2019 on 60 patients undergoing thoracic and abdominal surgery selected by convenience sampling, and they were randomly assigned to the intervention and control groups. The intervention (local cold therapy) was performed for 48 hours after full consciousness, three times a day for 20 minutes to the intervention group. Data were collected before and after the intervention using a demographic questionnaire, pulse oximetry device, and thermometer. The data were analyzed based on the independent samples t-test, paired-samples t-test, and chi-square and Fishers’ exact tests by SPSS version 20 software. Results: The mean arterial blood oxygen saturation percentage (O2Sat%) during the intervention significantly increased in both groups (P < 0.05), but the rate of increase was significantly higher in the local cold group (P < 0.05). The results of within-group research showed that the mean temperature had significant differences in the local cold therapy group (P < 0.05), but the mean body temperature did not show a significant difference between the two groups (P < 0.05). Conclusions: Local cold therapy can be effectively trained and used by nurses to improve the O2Sat%. It did not affect postoperative body temperature. Further studies must be conducted to investigate the effects of local cold therapy on postoperative body temperature changes.

The Effects of Chewing Gum on Nausea, Vomiting, and Intestinal Functions of Surgical Patients

Background: It is important to resume regular functions of the digestive system as soon as possible after surgery. It has been reported that chewing gum can be used in this regard. Objectives: This study aimed to evaluate the effect of chewing gum on nausea-vomiting and bowel function in surgical patients. Methods: A total of 60 patients with cholecystectomy and herniotomy (30 controls [non-chewing gum] and 30 interventions [chewing gum]) were enrolled in this controlled experimental study. The intervention group was provided to chew gum 3 times for 15 - 30 minutes with a 2-hour interval. Both control and intervention groups were evaluated 6 and 24 hours after being taken to the surgical service using the nausea-vomiting, intestinal functions monitoring form. Results: A statistically significant difference was found between the control and intervention groups 0 - 6 hours after surgery (χ2 = 4.320, P < 0.05). The intervention group was found to be discharged earlier than the control group (χ² = 4.286, P < 0.05; Z = -2.053, P < 0.05), and the difference was significant. It was found that the intervention group suffered 5.09 times less vomiting compared to the control group 0 - 6 hours after surgery. Conclusions: The positive effects of chewing gum on nausea, vomiting, intestinal function, and early discharge were found. It is recommended that chewing gum be included in nursing interventions for patients after surgery.

Effect of Self-care Training on Upper Limb Function and Pain After Breast Cancer Surgery

Background: Breast cancer patients who undergo mastectomy encounter numerous problems, the most annoying of which is lymphedema followed by pain and decreased function in the affected limb. Objectives: This study examined the effect of self-care training on upper limb function and pain after breast surgery. Methods: This quasi-experimental study was performed on two groups of 60 patients with breast cancer in the Oncology Ward of Zahedan University of Medical Sciences in 2021. The patients were selected based on the inclusion criteria and through convenience sampling and were then randomly divided into intervention and control groups. The patients in the intervention group attended self-care training and exercise programs implemented in five sessions in addition to the routine care. One and three months after the intervention, upper limb function and pain were measured with DASH and McGill pain questionnaires. The repeated measures analysis of variance (ANOVA) and Bonferroni test were used to compare the pre-, and post-intervention mean scores and mean differences in the two groups. Results: The mean scores of upper limb function one and three months after the training program in the intervention group were lower than the mean scores of the control group. In other words, the quality of upper limb function was not significantly different despite the changes in the first month, but upper limb function significantly improved three months after the intervention (P < 0.001 vs. P = 0.06). The mean pain scores before, one month, and three months after the intervention in the intervention group were 10.4, 35.7, and 6.26, respectively, and the corresponding values in the control group were 10.8, 41.7, and 21.1, respectively, showing significant differences between the two groups, with the intervention group having lower pain scores than the control group (P = 0.001). Conclusions: Since lymphedema and its consequences, including decreased upper limb function and pain, are very serious issues, medical staff can give priority to this training program and implement it to prevent and control these complications.

The Effect of Schema Therapy on Psychological Capital and Vulnerable Attachmenin Women with Breast Cancer

Background: Cancer causes psychological problems, such as anxiety, depression, post-traumatic stress, feelings of sadness, and anger, and family problems. Objectives: This study aimed to evaluate the effect of schema therapy on psychological capital and vulnerable attachment in women with breast cancer. Methods: The research method was quasi-experimental with a pretest-posttest design and a control group. The statistical population included all women with breast cancer admitted to the Imam Khomeini Hospital, Tehran, Iran, from 23/07/2019 to 20/11/2019. The total number of the patients was 51, of whom 30 were purposefully selected and randomly assigned to an experimental and a control group (15 people in each group). The experimental group was exposed to schema therapy for 11 weekly 90-minute sessions, while the control group did not receive any training. The Luthans Psychological Capital Questionnaire and the Vulnerable Attachment Questionnaire were used to collect data. The collected data were analyzed using multivariate analysis of covariance in SPSS-21 software. Results: The results of paired t-test showed a significant difference between the mean scores of the components of psychological capital and vulnerable attachment in the two experimental and control groups. Therefore, it can be stated that the effectiveness of schema therapy was associated with increased self-efficacy (P = 0.013), hope (P = 0.001), resilience (P = 0.034), optimism (P = 0.001), and decreased vulnerable attachment (P = 0.029). Conclusions: Based on the findings of this study regarding the effect of schema therapy on improving psychological capital and reducing vulnerable attachment, it can be concluded that schema therapy can be used as an effective intervention along with other therapies to reduce the problems of women with breast cancer.

Efficacy of Psycho-educational Program on Burden of Caregivers of Children with Epilepsy: A clinical trial

Background: Long-term care of the children with epilepsy and lack of psycho-educational training will lead to caregiver burden. Objectives: The aim of this study was to evaluate the effect of a psycho-educational training program on caregiver burden in families with pediatric epileptic children. Methods: This is a clinical trial study with two groups of experimental and control with three stages of Before, Immediately later, One month after the intervention. The population of the study consisted of family caregivers of children with epilepsy referring to Imam Hossein and Kashani Hospitals in Isfahan, Iran. Seventy families of children (ages 6 - 18years) with epilepsy participated in this study in 2018. The samples were randomly assigned to experimental (35) and control (35) groups using sequential convenience sampling method. The experimental group received a psycho-educational training program in eight sessions (90-minute) in four groups (8 - 9 members), and training was held two sessions a week. The control group participated in three sessions and expressed their problems and experiences. Data were collected using a demographic questionnaire and Zarit Burden Interview (ZBI) that consisted of 22 items and a 5-point Likert scale. Descriptive and inferential statistical methods and SPSS18 were used for data analysis. Results: Before the intervention, there was no statistically significant difference between the two groups of experimental and control in terms of caregiver burden (P = 0.917). However, there was a significant difference between the three time stages in the intervention group after the intervention (P < 0.05; f = 3.511). Meanwhile, the mean score of caregiver burden decreased during the intervention period than before the study (P < 0.05; f = 166.60), while the mean score of caregiver burden did not increase significantly in the control group over time (P = 0.036). Conclusions: The results showed that in a family with school-age epileptic children, appropriate programs and training methods are needed to decrease caregiver burden; so it is necessary to develop and use such programs by the treatment team members.

Effects of Two Different Preoperative Doses of Pregabalin on Postoperative Pain After Lumbar Disc Herniation Surgery

Background: Postoperative pain is a common and significant complication, and there are several ways to control it. In recent years, there has been a growing tendency to use pregabalin to control pain. Objectives: This study aimed to compare the effects of two different doses of pregabalin on postoperative pain after lumbar disc herniation surgery. Methods: This clinical trial study was performed on 90 patients undergoing elective herniated disc surgery in Khatam Al-Anbia Hospital of Zahedan, Iran, using random sampling. The patients were divided into three groups, including those receiving high dose pregabalin (150 mg), low dose pregabalin (75 mg), and placebo. The three groups were compared regarding postoperative pain, the received dose of analgesic, and the severity of side effects. The data were analyzed based on the Chi-square test and one-way analysis of variance using SPSS software (version 18). Results: In this study, the mean age of the patients was 43.9±6.7 years. The mean postoperative pain was significantly lower in both pregabalin groups than the placebo group (P < 0.05). Moreover, the mean postoperative pain in the high-dose pregabalin group was less than that of the low-dose group; however, the difference was not statistically significant (P > 0.05). Analgesics were needed for 8 patients (26.7%) of the low-dose pregabalin group. Furthermore, 7 patients (23.3%) of the high-dose pregabalin group and 16 patients (53.3%) of the placebo group also needed analgesics (P = 0.028). Additionally, 5 (16.7%), 8 (26.7%), and 4 (13.3%) patients in the low-dose pregabalin group, high-dose pregabalin group, and placebo group complained of side effects (P = 0.390). Conclusions: The present study showed that pregabalin significantly reduces postoperative pain and the required dose of analgesia. On the other hand, pregabalin complications are minor and can be neglected.

The Effect of the Behavioral Systems Model on the Concern of Mothers of Children Admitted to the Surgical Ward

Background: The crisis caused by the child's illness and hospitalization affects all family members. Fear, worry, and anxiety are common issues of hospitalized children’s mothers. Betty Newman's system model plays a vital role in adapting to stress detection and control. Objectives: This study aimed to examine the effect of the behavioral systems model on the concerns of mothers of children admitted to the surgical ward. Methods: This quasi-experimental study was conducted on 60 mothers of children admitted to the surgical ward of the Mousavi Hospital, Gorgan, Iran, in 2020. The participants were selected using convenience sampling and then divided into test and control groups using non-probability sampling. According to Neuman's systems model, participants in the test group received nursing care in 3 - 4 sessions (each lasting 30 - 45 minutes). Participants in the control group received only routine ward care. Data were collected using the Parental Concern Scale and analyzed with IBM SPSS Statistics 21 software using statistical tests (analysis of covariance, unpaired samples t-test, and paired sample test). Results: The mean score of maternal concerns before the intervention was 42.6 ± 3.06 in the control group and 43.21 ± 2.27 in the test group. The results of the independent samples t-test did not show any significant difference between the groups in terms of maternal concerns (P = 0.11). The mean post-intervention maternal concern score was 37.6 ± 2.71 and 41.716 ± 2.55 in the test and control groups, showing a significant difference between the groups as indicated by the t-test results (P < 0.01). However, the paired t-test outcomes showed no difference in the mean maternal concern score in the control group before and after the intervention (P = 0.92). In contrast, there was a significant difference in the mean maternal concern score in the test group before and after the intervention (P < 0.01). Conclusions: Given the effectiveness of Betty Neuman’s systems model, it can be used as a low-cost, effective care method to reduce maternal stress as the model was developed for understanding clients’ and caregivers’ needs and reducing their stress.

Barriers to Palliative Care in the Neonatal Intensive Care Unit from Nurses’ Perspective: A Qualitative Study

Background: The American Academy of Pediatrics and the National Association of Neonatal Nurses recommend that palliative care be provided as standard care in neonatal intensive care units (NICUs). Objectives: The present study aimed to explain the nurses' experiences of barriers to palliative care in NICUs. Methods: This qualitative study was conducted using the content analysis approach in NICUs of Beheshti and Amin hospitals in Isfahan in 2020. The data were collected using semi-structured in-depth interviews with 12 nurses who had palliative and end-of-life care experiences for infants and families. The nurses were selected using purposive sampling. The duration of each interview varied from 25 to 50 minutes. Data were analyzed using conventional qualitative content analysis conducted inductively with Graham and Lundman’s approach. The criteria proposed by Guba and Lincoln were used to ensure the credibility and reliability of the data. Results: Three main categories were extracted from the data, including unfavorable conditions (subcategorized into “unsuitable physical environment” and “shortage of nurses”), nurse's mental problems (with the subcategories of “nurses’ mental problems in providing neonatal care” and “nurses’ mental problems in providing family care”) and challenges ahead (with the subcategories of "parental presence challenge” and “doctor's instructions challenge”). Conclusions: The findings of the present study revealed the barriers to palliative care for infants and families in NICUs. Given the importance of palliative care in NICUs, effective measures must be taken to overcome these barriers.

Effect of Family-centered Empowerment Model on Quality of Life of Patients with Hypertension

Background: Nowadays, the high prevalence of hypertension and its serious complications for affected patients have made this disease a major health issue worldwide. Hypertension, like other chronic diseases, reduces the patients’ quality of life. Maintaining and improving their lifestyles requires the serious support of families. Objectives: This study aimed to explore the effect of the family-centered empowerment model on the quality of life of patients with hypertension. Methods: This clinical trial was performed on 70 hypertensive patients who were referred to two comprehensive health centers in Zahedan University of Medical Sciences in Zahedan, southeastern Iran, in 2020. The participants were selected and randomly allocated based on the inclusion criteria to the intervention (n = 35) and control (n = 35) groups using the consort. The participants in the intervention group received training in four 60-min sessions individually based on the family empowerment model. To collect data, a personal information form and the Quality of Life Questionnaire for hypertensive patients were used. The questionnaire was completed before the intervention and one and three months after the intervention by a self-report method. The collected data were analyzed by SPSS-22 using the independent samples t test, chi-square test, and repeated-measures analysis of variance. Results: The results of repeated-measures analysis of variance regarding the effect of time and group on the quality of life showed a statistically significant difference in the second and third phases between the two groups. In other words, the two variables of intervention and time affected the mean score of quality of life, and a statistically significant difference was observed in the measured time intervals (P < 0.001). Conclusions: This study showed that implementing the family-centered empowerment model improves the quality of life of patients with hypertension. Therefore, we recommend employing this method by nurses to engage the patients with chronic diseases and their families in the process of treatment.