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IRCT2015112925288N1 IRCT 2016-10-13 Vice chancellor for research, Mashhad University of Medical Sciences Effect of intentionality presence of Cardiac Artery Surgery The effect of holistic nurse's intentional presence on the depression, stress and anxiety of the patients undergoing coronary artery bypass graft 2016-04-19 anticipated 80 Complete https://irct.ir/trial/21178 interventional Randomization: Randomized, Blinding: Not blinded, Placebo: Not used, Assignment: Parallel, Purpose: Supportive. N/A Coronary artery disease. Intervention 1: In control group: In the beginning of patients’ admission to open heart surgery ward, subjects’ consent was obtained and their demographic information was obtained by a questionnaire examined their anxiety, stress, and depression and routine measures were taken for patients. In addition, educational pamphlets available in the ward along with educational pamphlets related to relation were provided for patents. During patient discharge, questionnaire assessing the anxiety, stress, and depression DASS 21 was completed again. In the control group, relaxation techniques and training to patients were performed trough educational pamphlets (Appendix 10) without the presence of a nurse (researcher), but measuring vital signs were measured and recorded during the four stages similar to experimental group. Intervention 2: Experimental group: intervention begins from patient hospitalization time in the open-heart surgery time. After introducing himself to patients, completing the demographic form and conscious consent of patient, and completing assessing the anxiety, stress and depression of patient by DASSS 21, researcher implemented the presence process at three levels of 1. Physical presence, 2. Mental presence and 3. Therapeutic presence. Accordingly, nurse will be able to select and use the best method for patients among the holistic methods based on unique investigation of each patient and determining the stressful resources, using strategies such as using and training relation or training the patient on unknowns, by relying on his specialized skill and knowledge, his nursing diagnoses (Table 3-1), and based on patient priority. Specifically, presence of nurse depends on individual characteristics of nurse, individual characteristics of client, characteristics shared in the communicative space of nurse-client, an appropriate environment to do communicative task, and performance decisions of nurse. The first session of intended presence in the open-heart surgery ward and before surgery was implemented. The second session was implemented after patient recovery in the intensive care unit and third and fourth sessions were implemented in the heart surgery ward. During nurse-client interaction, there are points the probable dose of presence. Specifically, relying on his clinical skill and his previous experiences in the presence process, nurse interprets the latent delicate signs and objective needs of the patient, and he deliberates and makes decision in the special moment on the most appropriate presence dose by considering environmental factors. On average, presence dose is determined based on patient’s need in each shift and 30 to 45 minutes has been considered (Figure 3-10. If patient needed, number of therapeutic sessions and presence dose might increase. After therapeutic sessions of presence, on the patient discharge, patient complemented the questionnaire assessing the anxiety, stress, and depression DASS 21 again.
public Nahid Aghedati
West Ibn-e-Sina st.
Mashhad Iran (Islamic Republic of) +98 51 3859 1511 Aghebatin1@mums.ac.ir Mashhad University of Medical Sciences scientific Nahid aghebati
West Ibn-e-Sina, School of Nursing and Midwifery
Mashhad Iran (Islamic Republic of) 9187113648 +98 51 3859 1511 Aghebatin1@mums.ac.ir; Khajianz1@mums.ac.ir Mahhad University of Medical Sciences Iran (Islamic Republic of) Inclusion criteria of study 1. Willingness to participate in the study 2. Age between 38 and 75 years 3. Having at least the literacy of writing and reading 4. Having an elective surgery 5. The ability to communicate with researcher 6. Lack of psychological disorders 7. Non- use of antipsychotic drugs 8. Candidate for coronary artery bypasses graft (CABG) 9. Lack of drug addiction Exclusion criteria of study: 1. Refusing from continued participation in the study and collaboration with researcher 2. Incidence of physical disorders during the study (drainage that requires for operating room again) 3. Death of subject of study 4. Postoperative cognitive dysfunction (delirium, lack of knowledge of time, place, and person) 5. Late recovery and prolonged hospitalization (recovery after 6 hours or hospitalization more than 2 days in intensive care unit) 6. Heart surgery for the second time 7. Postoperative drug addiction 38 years 70 years Both 125.1 Atherosclerotic heart disease Treatment - Other Behavior In control group: In the beginning of patients’ admission to open heart surgery ward, subjects’ consent was obtained and their demographic information was obtained by a questionnaire examined their anxiety, stress, and depression and routine measures were taken for patients. In addition, educational pamphlets available in the ward along with educational pamphlets related to relation were provided for patents. During patient discharge, questionnaire assessing the anxiety, stress, and depression DASS 21 was completed again. In the control group, relaxation techniques and training to patients were performed trough educational pamphlets (Appendix 10) without the presence of a nurse (researcher), but measuring vital signs were measured and recorded during the four stages similar to experimental group. Experimental group: intervention begins from patient hospitalization time in the open-heart surgery time. After introducing himself to patients, completing the demographic form and conscious consent of patient, and completing assessing the anxiety, stress and depression of patient by DASSS 21, researcher implemented the presence process at three levels of 1. Physical presence, 2. Mental presence and 3. Therapeutic presence. Accordingly, nurse will be able to select and use the best method for patients among the holistic methods based on unique investigation of each patient and determining the stressful resources, using strategies such as using and training relation or training the patient on unknowns, by relying on his specialized skill and knowledge, his nursing diagnoses (Table 3-1), and based on patient priority. Specifically, presence of nurse depends on individual characteristics of nurse, individual characteristics of client, characteristics shared in the communicative space of nurse-client, an appropriate environment to do communicative task, and performance decisions of nurse. The first session of intended presence in the open-heart surgery ward and before surgery was implemented. The second session was implemented after patient recovery in the intensive care unit and third and fourth sessions were implemented in the heart surgery ward. During nurse-client interaction, there are points the probable dose of presence. Specifically, relying on his clinical skill and his previous experiences in the presence process, nurse interprets the latent delicate signs and objective needs of the patient, and he deliberates and makes decision in the special moment on the most appropriate presence dose by considering environmental factors. On average, presence dose is determined based on patient’s need in each shift and 30 to 45 minutes has been considered (Figure 3-10. If patient needed, number of therapeutic sessions and presence dose might increase. After therapeutic sessions of presence, on the patient discharge, patient complemented the questionnaire assessing the anxiety, stress, and depression DASS 21 again. Anxiety. Timepoint: Before and then after intervention. Method of measurement: Dass21 scal and stressors. Stress. Timepoint: Before and then after intervention. Method of measurement: Dass21 scal and stressors. Depresion. Timepoint: Before and then after intervention. Method of measurement: Dass21 scal and stressors. Vice chancellor for research, Mashhad University of Medical Sciences Approved 2016-04-17 Mashhad University of Medical Sciences Four ways PhD, School of Nursing and Midwifery, Mashhad Jarjani Mashhad Iran (Islamic Republic of)