Background and Purpose: Pain perception with arteriovenous fistula (AVF) cannulation is a major concern among patients undergoing hemodialysis. This study aimed to compare the efficacy of cryotherapy and placebo in the reduction of AVF puncture-related pain in hemodialysis patients. Methods: This randomized clinical trial was conducted on 50 patients undergoing hemodialysis selected via random sampling. Patients were randomly divided into two groups of intervention and control. Patients in the intervention group received cryotherapy using ice cubes wrapped in latex gloves, which were placed on the back of the hands without AVF (between the index finger and thumb). The same process was performed on the patients of the control group by using wooden cubes as placebo instead of ice cubes. Pain perception of the patients was recorded during two consecutive hemodialysis sessions using a visual analogue scale. Data analysis was performed in SPSS V.13 using Chi-square and independent T-test. Results: With cryotherapy, scores of AVF puncture-related pain significantly reduced from 5.9±0.96 in session one (routine care) to 3.2±1.71 in session two of hemodialysis. However, no significant difference was observed between the two sessions in patients of the control group (P=0.07). Conclusion: According to the results of this study, cryotherapy, as a non-pharmacological and complementary approach, could be effective in the prevention of the pain associated with AVF cannulation. Therefore, it is recommended that nurses apply this method before AVF cannulation in order to alleviate pain intensity in hemodialysis patients.

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Background and Purpose: Anxiety is a common problem associated with invasive medical procedures, especially in patients undergoing coronary angiography. As an intensifier at cardiovascular reactions, anxiety poses significant risk to the health of patients undergoing angiography. Researchers believe that use of Benson's relaxation technique could reduce anxiety in different patients. This study aimed to evaluate the effect of Benson's relaxation technique on the anxiety of patients undergoing coronary angiography. Methods: This randomized clinical trial was conducted on 70 patients who were candidates for coronary angiography in Mazandaran Heart Center in Sari, Iran in 2014. Patients were selected via randomized sampling and divided into two groups of intervention (n=35) and control (n=35). Data collection tools included demographic questionnaire, Spielberger's State-Trait Anxiety Inventory (STAI), and hemodynamic variables recording sheet. Data analysis was performed in SPSS V. 16 using Chi-square, dependent and paired T-test, and Mann-Whitney U test. Results: Both study groups were homogenous in terms of age, gender, marital status, education level, disease history, and health insurance status. Use of Benson's relaxation technique significantly decreased anxiety in the intervention group (P=0.0001). However, no significant difference was observed in the systolic blood pressure, respiratory rate and heartbeat parameters between the study groups (P=0.0001). Conclusion: According to the results of this study, use of Benson's relaxation technique before coronary angiography reduced the level of anxiety in the patients. Therefore, this complementary approach could be used as an effective healthcare measure without any side effects to provide mental support for patients before invasive procedures, such as angiography.

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Background and Purpose: The emergency severity index (ESI) triage system has been recommended by the Ministry of Health to classify patients at emergency departments. This study aimed to assess the validity of ESI system (version 4) in the emergency department of a teaching hospital. Outcome measures were hospitalization, emergency department (ED) length of stay, resource consumption, in-hospital mortality, and patient service costs. Methods: In this retrospective cross-sectional study, medical records of 562 ED patients were reviewed to determine the ESI level and outcome measures in April 2013. Possible correlations were assessed using Phi and Cramer's V and Spearman's Rho. Data analysis was performed in SPSS V.16, and P value of 0.05 was considered significant. Results: In this study, frequency of five ESI levels (1-5) was 24, 14, 365, 158 and 0, respectively. In addition, Phi and Cramer's V for hospitalization and mortality were 0.350 (P<0.001) and 0.345 (P<0.001), respectively. Spearman's Rho for patient service costs, ED length of stay, and resource consumption were -0.434 (P<0.001), -0.015 (P=0.362), and -0.411 (P<0.001), respectively. According to our findings, the association between triage levels and resource consumption was more significant compared to other outcome measures. Conclusion: According to the results of this study, ESI triage ratings could successfully predict patient outcomes in terms of hospitalization, in-hospital mortality, resource consumption, and patient service costs. Therefore, use of this valid triage system is recommended for the arrangement of human and physical resources at emergency departments.

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Background and Purpose: Stress has adverse effects on the quality of sleep and professional life in nurses engaged in intensive care units (ICUs). This study aimed to evaluate the relationship between the qualities of work life and sleep in nurses employed in the ICUs of Mazandaran province in Iran. Methods: This cross-sectional, descriptive-correlational study was conducted on 180 nurses employed in the ICUs of teaching hospitals affiliated to Mazandaran University of Medical Sciences, Iran in 2015. Participants were selected via stratified random sampling. Data collection tools included demographic questionnaire, Walton's Quality of Work Life (QWL), and Pittsburgh Sleep Quality Index (PSQI). Data analysis was performed in SPSS V. 18 using descriptive and inferential statistics (independent T-test, one-way ANOVA, Pearson's correlation-coefficient, and logistic regression analysis). Results: In this study, ICU nurses were dissatisfied with most of the dimensions associated with the quality of work life. Moreover, 49 participants (27.2%) had poor quality of work life, while 119 (66.1%) and 12 cases (6.7%) had moderate and high quality of work life, respectively. Also, 69 (38%) and 111 nurses (61.7%) were reported to have good and unfavorable sleep quality, respectively. A significant, inverse, linear correlation was observed between the quality of work life and sleep quality (P=0.012). Conclusion: According to the results of this study, quality of work life and sleep quality were moderate and unfavorable in the majority of ICU nurses, respectively. Moreover, sleep quality had a significant correlation with the quality of work life.

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Background and Purpose: Professional ethics is one of the foremost components of every occupation. The ethical standards are essential to the improvement of quality of care. On the other hand, job satisfaction is a critical challenge for healthcare organizations. This study aimed to evaluate the relationship between compliance with professional ethics and job satisfaction among nurses. Methods: This descriptive-correlational study was conducted on 142 nurses employed in the teaching hospitals of Sari, Iran. Participants were selected via stratified random sampling. Data collection tools were Cadozier's professional ethics questionnaire (2002), and Warr, Cook, and Wall's job satisfaction scale (1979). Data analysis was performed in SPSS V.14 using t-tests, Pearson's correlation-coefficient, and one- way Analysis of Variance (ANOVA). Results: In this study, the majority of the participants were female (90.1%), registered nurses (81.7%), and had bachelor's degree (92.3%). Mean scores of compliance with professional ethics and job satisfaction were 62.01±6.92 and 47.86±9.94, respectively. No significant correlation was observed between compliance with the professional ethics and job satisfaction (P=0.113). Moreover, there was a significant association between the observance of professional ethics and work experience of the nurses (P=0.032). Accordingly, nurses with more than 10 years of work experience had greater compliance with professional ethics. Conclusion: According to the results of this study, compliance with professional ethics and job satisfaction are independent from each other. This may be due to the fact that in nursing professional ethics has a intrinsic and independent feature in compared to other parameters, such as payment equity, job bonus, and promotion, which could increase or reduce job satisfaction among these healthcare providers.

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Background and Purpose: Upon centuries, wars have taken over countries due to theadvancement of sophisticated warfare,causingserious injuries among soldiers. Nurses are directly involved in preoperative and postsurgical patient care. One ofthe most remarkable contributions of the Iranian operating room nurses was to provide medical care for wounded soldiers in field hospitals during the Iran-Iraq war. This study aimed to explore the experiences of civilian operating room nurses infield hospitals at the frontlines during the Iran-Iraq war. Methods: This study was conducted using historical research methodology and oral history method throughin-depthinterviews with civilian nurses engaged inoperating rooms during the war.Participants were selected via snowball sampling. This study investigated nursing practice in operating rooms as recountedby 16 civilian nurses who served in field hospitals inthe Iran-Iraq war during 1980-1988. Results: This study had six descriptive themes focusing on the experiences of nurses engaged in operating rooms during theIran-Iraq war, and the results were obtainedin a narrative style. The main themes extracted from the study were”establishment of medical centers in the frontlines”, “organization of emergency medical teams”, “establishment of operating rooms”, “nursing duties inthe operating room”, “documentation of medical interventions”, and “vulnerability of nurses in the operating room”. Conclusion: The findings of this study will significantly enhance the current knowledge regarding operating room nursing practiceduring the Iran-Iraq war, enabling a greater understanding of this particular medical experience.

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Background and Purpose: Birth of a mentally retarded child is a significant challenge in every family and is associated with the possibility of parental stress and depression. This study aimed to evaluate the self-concept of mothers with educable mentally retarded (EMR) children. Methods: This cross-sectional study was conducted on 40 mothers with EMR children in the only special primary school for these children in Aran & Bidgol city in Isfahan, Iran. Data were collected using self-concept questionnaires. Data analysis was performed using descriptive statistics and Fisher's exact test in SPSS V.13. Results: In this study, total score of the self-concept of mothers was 29.95±7.60, which was relatively desirable. In addition, a significant correlation was observed between the age of children (P=0.02) and family income status (P=0.01) with the scores of maternal self-concept. Conclusion: According to the results of this study, higher family income and increased age of EMR children are associated with higher self-concept of mothers. It is recommended that future studies be performed on larger sample sizes in this regard.

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Background and Purpose: Despite extensive research on family planning and education, reproductive behavior of high-risk couples for thalassemia remains a major concern among medical professionals. This study aimed to evaluate the knowledge and attitude of carrier couples for transfusion-dependent thalassemia major (TDTM). Methods: This case-control study was conducted 327 carrier couples for thalassemia minor. Contact information of the couples was obtained from three healthcare centers randomly selected from the eastern, central and western parts of Mazandaran province, Iran. To match the socioeconomic status, two control families (right and left neighbors) were interviewed per each carrier couple. Epidemiological characteristics and knowledge of the carrier couples were assessed via 10 and 20 questions, respectively, and scores above 15 were interpreted as adequate knowledge. Moreover, attitude of the subjects was evaluated via 16 items scored based on a four-point Likert scale. Data analysis was performed in SPSS V.16 using Mann-Whitney U test and T-test for the comparison of study groups, and P value of less than 0.05 was considered significant. Results: In total, 327 high-risk couples for minor thalassemia and 660 control families were enrolled in this study. Among the subjects, 32.6% and 22.3% had adequate knowledge about thalassemia. In addition, attitude of the carrier couples was positive in 58% and 41% of the cases. Also, 30.5% and 31.2% of case and control subjects had favorable socioeconomic status, respectively. Conclusion: According to the results of this study, knowledge of carrier couples was adequate with regard to TDTM, and they had a positive attitude toward receiving prenatal diagnosis for this syndrome. However, reproductive practice of high-risk couples was relatively poor. Therefore, it is recommended that reproductive behavior of high-risk couples for TDTM be monitored regularly in order to improve their practice.

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Background and Purpose: Identification of the effects of sleep disturbances on the quality of life could result in proper treatment of patients with heart failure. This study aimed to investigate the relationship between sleep disorders and erectile dysfunction, depression and quality of life in male patients with systolic heart failure. Methods: This correlational study was conducted on 100 male patients with systolic heart failure selected by convenience sampling. Data were collected using Epworth Sleepiness Scale (ESS), STOP-Bang questionnaire, Pittsburgh Sleep Quality Index (PSQI), Minnesota Living with Heart Failure questionnaire (MLHFQ), Center for Epidemiologic Studies Depression Scale (CES-D) and International Index of Erectile Function (IIEF-5). Data analysis was performed using descriptive statistics, Pearson's correlation-coefficient and linear regression model. Results: In this study, sleep quality (P<0.001) and possibility of obstructive sleep apnea (OSA) (P=0.001) were significantly associated with depression and could explain 32.6% of variance in depression. In addition, possibility of OSA (P=0.006) was associated with erectile dysfunction and could explain 12% of variance in erectile dysfunction. Also, possibility of OSA (P=0.001) and sleep quality (P<0.001) had a statistically significant correlation with quality of life and could explain 36% of variance in quality of life. Conclusion: According to the results of this study, poor sleep quality and sleep-disordered breathing were negatively correlated with mood, sexual function and overall quality of life in male patients with systolic heart failure. Therefore, proper screening and treatment of sleep disorders in patients with heart failure is of paramount importance.

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Background and Purpose: Severity of illness scoring systems is used for the classification of patients to receive medical services, predict the risk of mortality, determine hospital bed occupancy, and assess treatment progress. In Iran, these scoring systems are not frequently used due to the lack of knowledge of medical staff. This study aimed to evaluate the effect of education on the knowledge and attitude of intensive care unit (ICU) staff towards the use of predictive illness severity scoring systems in Imam Khomeini Hospital of Sari, Iran. Methods: This pre-experimental study was conducted using a researcher-made questionnaire to assess the knowledge and attitude of ICU staff towards the use of illness severity scoring systems. Study population consisted of all the ICU nurses and physicians engaged in Imam Khomeini Hospital of Sari, Iran. In total, 60 participants were selected via census sampling. All the participants received training on the application of disease severity scoring systems. Knowledge level and attitude of the participants were assessed 10 days after the intervention. Data analysis was performed in SPSS V. 18 using descriptive and inferential statistics, Mann-Whitney U test, and repeated measures one-way analysis of variance (ANOVA). Results: In this study, 43 participants (72%) were female, and the mean age of the subjects was 32.5±7.3 years. Mean score of knowledge increased from 3±5.25 before the intervention to 18.4±0.96 after the intervention. With regard to attitude, mean scores reached from 100.42±11.34 before the intervention to 122.30±9.81 after the intervention (P=0.001). Conclusion: After receiving education on the function of disease severity scoring systems, level of knowledge in the ICU nurses improved from low to high, while their attitude improved from moderate to excellent. Therefore, it is recommended that predictive patient scoring systems be included in medical and nursing curricula. Furthermore, new strategies must be considered to apply these tools in all the critical care units of the country.

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