OTHERS_CITABLE Background: Patients in cardiac surgery intensive care units are affected by different discomforting factors and use different strategies for their management. Objective: The aim of this study was to examine the relationship of discomforting factors with coping strategies among patients hospitalized in cardiac surgery intensive care units. Methods: This descriptive - correlational study was done in 2016. A convenience sample of 110 patients was drawn from the cardiac surgery intensive care unit of Amir - al - momenin heart surgery center, Kordkuy, Iran. Data were collected using a demographic questionnaire, the Discomforting Factors in Cardiac Surgery Intensive Care Unit Questionnaire, and Jalowiec Coping Scale. Pearson correlation analysis, the one - way analysis of variance, the paired - sample t - test and the Tukey’s post hoc test were used to analyze the data. Data analysis was performed via the SPSS software (v. 16.0) and at a significance level of less than 0.05. Results: The mean score of discomforting factors was greater than the moderate level (74.08 ± 16.93). Participants used emotion - focused coping strategies more than problem-focused ones. Discomforting factors were inversely correlated with problem - focused strategies (r = - 0.266; P = 0.005) and directly correlated with emotion-focused strategies (r = 0.247; P = 0.009). Conclusions: Patients in cardiac surgery intensive care units suffer from the negative effects of different discomforting factors and use emotion - focused coping strategies more than problem - focused strategies for the management of the factors. Keywords: Discomforting Factors, Coping Strategies, Cardiac Surgery Intensive Care Unit http://jccnursing.com/article-1-408-en.pdf 2019-06-23 1 8 Masoumeh Rahimi 1 AUTHOR Shohreh Kolagari 2 AUTHOR Khadijeh Yazdi 3 AUTHOR Mohammad Aryaie 4 AUTHOR

OTHERS_CITABLE Background: Therearemanyperformanceobstaclesinintensivecareunits(ICU)thatcanwasteanurse’stimeandenergy. Detectionandeliminationof theseobstaclescanimproveefficacyinICUs. Objectives: ThisstudywascarriedouttoidentifytheperformanceobstaclesexperiencedbynursesinICUsof selectedhospitalsin Kashan,Iran,2015. Methods: In this descriptive analytical cross-sectional study, all 80 nurses working in ICUs reported their performance obstacles in 240 working shifts. The research instrument had 2 parts: 1- information of nurses and their working shift; 2- nursing performance obstacles questionnaire of Gurses. The questionnaire evaluates performance obstacles in 4 dimensions of environment, task,technology,andorganization. ThedataanalyzedwiththedescriptiveandanalyticalstatisticsincludingMann-WhitneyUand Krukall-Wallistests,andmultipleregressionanalysisusingSPSS16. Results: The most common obstacles were: receiving too many phone calls from family members (75%), delay in getting medicationsfrompharmacy(54.6%),insufficientspacetositdownanddopaperwork(52.9%),anddisorganizedunit(51.6%). Inthefieldof technology, havingtouseequipmentinpoorcondition(35%)wasthemostfrequentobstacle. Delayinseeingnewmedicalorders (48.3%)andinadequateinformationfromphysicians(30.4%)wereothercommonobstacles. Thenurseswithlessthan3yearsof experienceworkinginICUs,thoseworkingmorningshifts,andnurseswhohadadmittedmorepatientsreportedsignificantlymore obstacles. Conclusions: Nursing performance obstacles were different. Many obstacles such as receiving too many phone calls and having touseequipmentinpoorconditioncanbemanagedbysimpleinterventionssuchasusingtechnologytogiveinformationtothe familymembers.Managementpoliciesandenhancingteamworksareneededtoreduceobstaclessuchasinadequateinformation from physicians and disorganized unit. We need further studies, to evaluate how the elimination of these obstacles can improve thenursingcareinICUs. Keywords: CriticalCareNursing,IntensiveCareUnits,WorkPerformance,BarrierandPerception http://jccnursing.com/article-1-409-en.pdf 2019-06-23 1 6 Zahra Rajaeian 1 AUTHOR Negin MasoudiAlavi 2 AUTHOR

OTHERS_CITABLE Background: Cardiopulmonaryresuscitation(CPR)procedureconsistsof measurestakentorestoretheactsof theheartandthe braininapersonwhohaslosttheirownconsciousness. Thus,thepurposeof thepresentstudywastoinvestigatethesuccessrate of CardiopulmonaryResuscitation,survivalrateinpatients,andtheirrelatedfactorsinordertoassistinimprovingeffectiveconditionsandmeasureswithinhospitalstoincreasethesuccessrateof CPR. Methods: This cross-sectional analytic study was conducted in 2016. To this end, a total number of 199 patients affected with cardiopulmonaryarrestandundergoingtheCPRprocedureintheemergencywardsandotherhospitalsunitsinIranwererecruited using a convenience sampling method. Then, patient information was collected through a researcher-designed checklist as well as a review of clinical records. The data were also analyzed via the SPSS.16 software. Data analysis was similarly performed using descriptivestatisticsandChi-squareandt-test. Results: The mean age of patients was 44 years. The result of 36.7% of CPR procedures conducted was reported successful, however,only4% of patientsfinallysurvived. Ingeneral,thefindingsrevealedthatfactorssuchasage,gender,hospital,historyof prior diseases, checked initial rhythm, work shift, time of work shift change, pre-resuscitation intubation status, and underlying cause of cardiopulmonary arrest had no effects on the success rate of CPR procedure. However, location of the occurrence of cardiopulmonaryarrest(P=0.03)andspecialtyof physiciansinchargeof resuscitationteams(P=0.01)wereamongthefactorsaffectingthe successrateof CPRprocedure. Furthermore, checkedinitialcardiacrhythm(P< 0.0001)andahistoryof priorheartdiseases(P= 0.05)inpatientshadimpactsontheirsurvivalrate. Conclusions: Given the simplicity and teachability of the principles of basic life support (BLS), health status, and survival rate in patients can be easily and significantly promoted through the public education of the initial resuscitation measures. Moreover, according to the investigations made in this respect, post-resuscitation measures can dramatically affect the survival rate of individuals.Therefore,itissuggestedtoinvestigatepost-resuscitationmeasuresinotherstudiesofprospectivetypeinordertopropose strategiestoimprovethesurvivalrateof patients. Keywords: CardiopulmonaryResuscitation,HeartArrest,SuccessRate,SurvivalRate http://jccnursing.com/article-1-410-en.pdf 2019-06-23 1 5 Athare Nazri Panjaki 1 AUTHOR Narges Salari 2 AUTHOR Masoum Khoshfetrat 3 AUTHOR

OTHERS_CITABLE Background:Thesuccessof noninvasiveventilationdependsonmanyfactorsandeffectivedeliveryrequiresteamwork.Informationonthetherapeuticprogrammustbesustainedbyhealthcarestaffandfamily. Objectives: Investigatetheclinicalandcarefactorsthataffectthelevelof patientcompliancetononinvasiveventilation. Methods: A prospective, observational and multicentre study was conducted between November 1, 2015 and February 15, 2016 in three sub-intensive wards. A data collection tool was created with the working definition of “Patient intolerant to non invasive ventilation” and a structured interview was conducted to investigate patient experience of NIV. Statistical analysis was conducted withtheSTATAMP13software. Results: Coordination of patient-ventilator interaction prevents intolerance (OR = 0.68, 95% IC 0.46 - 0.98; P = 0.04). Overweight andobesepatientsshowedahigherprobabilityof intolerancetononinvasiveventilationwithrespecttounderweightandnormal weight patients (OR = 0.53, 95% IC 0.34 - 0.82; P = 0.005). Patients with a higher probability of intolerance experienced a NRS level of 4/5(OR=1.76, 95% IC1.30-2.41; P≤0.001)whilereceivingcontinuoustreatment(OR=1.26, 95% IC1.04-1.53; P=0.019). Patients in open-space settings experienced less intolerance (4.7 SD±1.2) with respect to patients in single rooms (2.5 SD±0.9). Anxious patientsdevelopedmoreintolerancethancalmandinformedpatients(OR=7.39,95% IC3.19-17.13;P≤0.001) Conclusions: Compliance to non invasive ventilation depends on multiple factors, including relational aspects that affect treatment success. Attention to patient comfort, pain control, and collaboration with the caregiver appear to have the most influence onpatientcompliance. Keywords: Nurses,Patients,NoninvasiveVentilation,IntensiveCareUnits,Compliance,Masks http://jccnursing.com/article-1-411-en.pdf 2019-06-23 1 4 Alessia D’Orazio 1 AUTHOR Antonella Dragonetti 2 AUTHOR Giorgio Campagnola 3 AUTHOR Cristina Garza 4 AUTHOR Fabrizio Bert 5 AUTHOR Simona Frigerio 6 AUTHOR

OTHERS_CITABLE Background:Patientshospitalizedincriticalcareunitsareatriskfordevelopingdifferenthealthproblemssuchassleepdisorders. Detectionofsleepdisordersisveryimportantandneedstheappropriatetools.Thisstudywasaimedtodeterminethepsychometric propertiesof RichardCampbellsleepquestionnaire. Methods:Thismethodologicalstudywasconductedinthecardiacsurgeryintensivecareunit(CICU)ofMilitaryHospitalofTehran in 2016. A standard translation of the questionnaire was provided, and face and content validity of the questionnaire were qualitatively evaluated by the main users (patients) and experts, respectively. Reliability of the questionnaire was determined using Inter-raterreliabilityandinternalconsistency. Inthisstudy,100patientswhomettheinclusioncriteriawereselectedusingconveniencesamplingmethod. Onthe2ndand3rddayafterthehospitalization, qualityof theirpastnight’ssleepwasmeasuredusing thequestionnaire. Results: The face and content validity of the questionnaire were qualitatively at desired level. The reliability of the questionnaire throughinter-ratercorrelationcoefficientandtheCronbach’salphavaluewere0.714(P< 0.0001)and0.906,respectively. Conclusions: Accordingtotheresults,RichardCampbellsleepquestionnaireisasimplevalidatedinstrumentthatcanbeusedby healthcareproviderssuchasnursestomeasurethequalityof sleepinpatientsincardiacsurgeryintensivecareunit(CICU). Keywords: Sleep,IntensiveCareUnit,Psychometrics,RichardCampbellSleepQuestionnaire http://jccnursing.com/article-1-412-en.pdf 2019-06-23 1 5 Ahmadali Amirifar 1 AUTHOR Abolfazl Rahimi 2 AUTHOR Fakhrudin Faizi 3 AUTHOR Masoud Siratinir 4 AUTHOR

OTHERS_CITABLE Background:Angiographyisthegoldstandardtestforthediagnosisofcoronaryarterydisease;however,morethan82% ofpatients have stress and anxiety before they undergo angiography, which significantly effects the diagnostic results. One of the common complicationsoftheangiographymethodthroughtheradialarteryistheoccurrenceofarterialspasmthatisseenmoreinpatients withsevereanxiety. ThecurrentresearchersbelievethatusingBensonrelaxationiseffectiveinreducingthepatient’sanxiety. Objectives: ThisstudywasdesignedtoevaluatetheBensonrelaxationmethodinpatientsundergoingradialangiography. Methods:Thisstudywasaclinicaltrial,whichwasperformedon60candidatepatientsundergoingcoronaryangiographybyradial methodatBaqiyatallahHospitalduringyear2017(N=60). Thesampleswererandomlyallocatedtotwogroups, interventionand control. The information gathering tools were demographic questionnaire, the Beck Anxiety Inventory (BAI), and hemodynamic variableschecklist. DataanalysiswasdonewiththeSPPSSV16softwareusingKolmogorov-Smirnovtest,Mann-Whitneytest,and paired-ttest. Results: The results showed a significant difference between the anxiety of the patients before and after the intervention in each group(P< 0.05). Thecomparisonof thetwogroupswiththepaired-ttestwasnotstatisticallysignificant. Theanxietyof patients aftertheinterventionwasdecreased,yetthisdecreasewasnotstatisticallysignificant. Conclusions: Benson’s relaxation method can be effective in reducing anxiety in angiography candidate patients. Accordingly, it mayalsobeeffectiveinreducingtheoccurrenceof radialarteryspasm. Keywords: Anxiety,BensonRelaxation,RadialAngiography http://jccnursing.com/article-1-413-en.pdf 2019-06-23 1 6 Yasser Moazami Goudarzi 1 AUTHOR Fataneh Ghadirian 2 AUTHOR Amir Vahedian 3 AUTHOR Amir Pishgoo 4 AUTHOR

OTHERS_CITABLE Background: The purpose of the study was to evaluate clinical manifestations of acute myocardial infarction as classified by age andgender. Methods: This cross sectional study was conducted in a coronary care unit of a regional urban medical center in northern Iran (Amol). Atotalof 366patientsdiagnosedwithacutemyocardialinfarctionwererecruitedfromJanuarytoJune2013. Patientdemographicinformation,pastmedicalhistory,andcurrentsymptomdatawerecollected. Results:Multivariatelogisticanalyseswereperformedtoidentifyriskpredictorsofmyocardialinfarctionpatientsclassifiedbyage andgender.Riskpredictorsforolderpatientsweredyspnea,OR=1.76(95% CI1.01,3.06),weaknessoddsratio=2.35(95% CI1.31,4.21), nausea odds ratio = 1.83 (95% CI 1.04, 3.20), vomiting odds ratio = 2.48 (95% CI 1.34, 4.57), fatigue odds ratio=1.87 (95% CI 1.02, 3.39), belching, odds ratio = 2.13 (95% CI 1.08, 4.20), and hiccups odds ratio = 2.81 (95% CI 1.25, 6.30). Sub group analysis in older women patientsidentifiedweaknessoddsratio=3.13(95% CI1.11,8.85),andbelchingoddsratio=34.70(95% CI3.86,312.2)asriskpredictors. Amongoldermenpatients,thepredominantsymptomsweresweatingoddsratio=3.74(95% CI1.06,13.2)andvomitingoddsratio =2.54(95% CI1.10,5.91). Conclusions:Thisstudyconcludesthatolderacutemyocardialinfractionpatientsweremorelikelytohavenon-specificsymptoms. Initial assessment for acute myocardial infarction should consider the possibility of non-specific clinical manifestations, such as weaknessandbelchinginolderwomen,andsweatingandvomitinginoldermen. Keywords: MyocardialInfarction,Age,Gender,SignsandSymptoms http://jccnursing.com/article-1-414-en.pdf 2019-06-23 1 9 Behzad Taghipour 1 AUTHOR Erika Sivarajan Froelicher 2 AUTHOR AmirHossein Goudarzian 3 AUTHOR Yiong Huak Chan 4 AUTHOR Hamid Sharif Nia 5 AUTHOR Ameneh Yaghoobzadeh 6 AUTHOR Ali Akbar Haghdoost 7 AUTHOR