[ effect of implementing clinical supervision model on the patient education outcomes]

Applying proper supervision model is an important factor in promoting the outcomes of the patient education which improves nursing care. The aim of this study was to assess the effect of Clinical Supervision Model on the outcomes of implementing patient education. [Patients' Attitude Toward Education by nurses, patient satisfaction from nurses' education and quality of patient education documentation]. This quasi-experimental study was conducted using static groups' comparison in which the control and experiment groups were compared by a posttest. Study samples included 72 patients who were matched and assigned into two distinct groups. Clinical Supervision Model was implemented through three steps in 3 wards of Samen-al-Aemme hospital in Mashhad for 6 months. The data were gathered by instruments including patient demographic information, patients' Attitude toward Education by Nurses Questionnaire, Patient Satisfaction from Nurses' Education Questionnaire and Quality of Patient Education Documentation check list. Validity of instruments was measured by content validity and reliability by split half and inter-rater. Data was gathered through interview and observation methods and analyzed by SPSS 11.5 software. The results showed significant difference in the quality of patient education documentation before and after implementing Clinical Supervision Model [P=0/0001]. Furthermore, results showed significant difference between patient satisfaction before and after implementing Clinical Supervision Model [P =0/02]. However there were not any significant differences between patients' attitude toward education before and after implementing Clinical Supervision Model Implementation of Clinical Supervision Model can develop nurses' knowledge and skills in patient education through organizing, implementing, and feedback. More studies are required in order to assess the effect of this model on other aspects of nurses' practice

[Barrier to forming and implementing academic service partnership in nursing; A qualitative study]

Clinical education is the responsibility of all those involved in delivering health care. As an international trend the development and implementing the partnership clinical education models is on the rise. To create a partnership program, it is needed to involve all the stakeholders in the planning and implementing and evaluation of this program so this study was investigate barrier to forming and implementing academic service partnership in nursing from the perspective of the all key stakeholders. This study was based on qualitative research method. A total of 15 nursing students, clinical educator, clinical nurses and nurse managers participated voluntarily in this study. Sampling was started purposefully and continued with snow-ball method. Data was obtained through semi-structured interviews, which recorded and subsequently transcribed. The analysis was carried out by qualitative content analysis method. Findings of the study yielded four significant themes. These include [1] organizational divergency [2] Overemphasizing on theory knowledge [3] Invisible wall. The process of development of the academic service partnership can be facilitated by defining a formal organizational relationship between academic and service institutes, clarifying roles and responsibilities of each staff institute regarding Clinical education, defining the clinical practice roles for nursing faculty members and emphasizing on the importance of nursing clinical practice

[ effect of a single dose of gabapentin on the rate of consumption of propofol and remifentanil during total intravenous anesthesia]

Gabapentin [structural analog of GABA], is an antiepileptic drug that its preoperative administration results in postoperative pain reduction. Considering the hypnotic effect of propofol, which is mediated by its attachment to GABAA, this hypothesis was propounded that administration of gabapentin can probably decrease the need for propofol and remifentanil during total intravenous anesthesia. Fifty patients scheduled for elective laparoscopic cholecystectomy, were assigned into two equal groups [n=25] in this randomized double blinded clinical trial. Study group received oral gabapentin [1200mg], and control group received placebo 3hrs before operation. Premedication and induction of anesthesia were the same in all patients. For the maintenance of anesthesia, oxygen and nitrous oxide [50%-50% mixture] and propofol and remifentanil infusion were used. The rate of propofol infusion was adjusted to maintain BIS in the range of 40- 60, and dose of remifentanil adjusted to maintain hemodynamic variables in the range of +/- 20% of baseline values. At the end of anesthesia the duration of anesthesia and the total amount of propofol and remifentanil used for every patient were recorded. The demographic parameters were similar in both groups [p>0.05]. Doses of propofol and remifentanil used for study group were significantly lower than doses used for control group [p<0.01]. The mean values of baseline systolic, diastolic, mean arterial, heart rates and BIS in the study group were lower than the corresponding values in the control group [p<0.05]. This study showed that a single dose of gabapentin before operation can decrease the need for propofol and remifentanil in total intravenous anesthesia during laparoscopic cholecystectomy

[Effective clinical instructor: a qualitative study]

Nursing is a practicing discipline. Clinical instructors need to acquire competence of an effective clinical instructor in order to make students ready to face the real world of providing care. Such characteristics get affected by socio-cultural background. In spite of many international quantitative studies, such characteristics haven't been defined clearly yet. The present study, therefore, aimed at investigating effective clinical instructor characteristics from the perspective of students and clinical instructors, qualitatively. Using qualitative method, semi-structured interviews were conducted with ten students and clinical instructors. All interviews were reordered and transcribed. The data were analyzed using constant comparative methods through qualitative content analysis method. Following themes were identified in data analysis: [1] recognition; [2] making clinical environments attractive; [3] communication skills; [4] clinical competencies [5] personal trait and [6] role model. Effective clinical instructors attract students to clinical education by identifying effective factors on clinical education, applying innovative methods in education, implement theoretical content in practice and having patient-center approach. They play as a role model for students with regard to their altruism, communication skills and having clinical competencies

[Clinical supervision system: a method for improving educational performance of nursing personnel]

Employing supervision methods which focuses on educational aspects may increase the effectiveness of nursing personnel's educational activities, especially patient education. The aim of this study was to investigate the effect of clinical supervision on the effectiveness of nurses' educational performance. This quasi-experimental study was conducted using static groups' comparison in which the control and experiment groups were compared by a post-test. Study samples included 72 patients who were matched and assigned into two distinct groups. Clinical supervision system was implemented through three steps in 3 wards of Samen-al-Aemme hospital in Mashhad for 6 months. The data gathering tool included patient information sheet, patient satisfaction from nurses' educational practice and rating scale of self-care knowledge and practice of patients. Data was gathered through interview and observation methods and analyzed by SPSS software. The mean scores of self-care knowledge and practice of the patients were 30.6 and 57.1 out of 100, in the control and experiment groups, respectively. The mean score of patients' satisfaction from nurses' educational practice was 19.6 in the control group and 20.9 in the experiment group, out of 24. So that, independent t-test showed a significant difference between these two groups. Implementing clinical supervision system through observation, feedback, discussion, and investigation, may develop nurses' knowledge and professional skills in patient education. Therefore, this supervision method could be regarded as an effective model for in-service education. More studies are required in order to investigate the effect of this model on other aspects of nurses' practice

[Evaluation of the effect of ketamine as oral premedication on quality of pediatric anesthesia]

Strange and unfamiliar setting of the operation room and also fear of operation cause numerous problems for the patient, parents of the patient and anesthesiologist. Prescription of intravenous sedatives or opiates in addition to their side effects leads to more fear and anxiety because of venipuncture. To prevent these problems, we prescribed oral sedatives. In this controlled double blind clinical trial, sixty children, aged 1-7 year were divided randomly into two groups; group 1 received oral Ketamine but placebo was prescribed for group 2. Behavioral changes together with heart rate and respiratory rate alternations were evaluated before and 30 minutes after prescription of the medication. The results of this study showed that the children who received oral ketamin were calmer and separated from their parents easier in comparison to those who received placebo, which showed a significant statistical difference [p<0.001]. Also heart and respiratory rates decreased in the patients of ketamine group which revealed a significant difference [p < 0.01]. It seems that prescription of oral ketamine as a premedication thirty minutes before anesthesia can produce appropriate sedation and a relative decrease in heart and respiratory rates in children, which in turn can lead to less panic, easier separation of children from their parents and facilitation of induction of anesthesia

effect of addition of intravenous nitroglycerin to lidocaine for improvement of quality of intravenous regional anesthesia

Disadvantages of intravenous regional anesthesia [IVRA] include slow onset, poor muscle relaxation, tourniquet pain, and rapid onset of pain after tourniquet deflation. In this randomized, double-blind study, we evaluated the effect of addition of nitroglycerine [NTG] to lidocaine for improvement of IVRA. Forty six patients [20-50 yrs] were randomly assigned into 2 equal groups. Under identical conditions, the control group received 3 mg/kg of lidocaine 0.5% diluted with saline, and the study group received an additional 200 microgram NTG. Vital signs and tourniquet pain were measured on the basis of VAS score and recorded before applying tourniquet and 5, 10, 15, 20, and 30 min after administration of anesthetic solution. The onset of sensory and motor block was measured and recorded for all patients. Severity of pain was measured at 5 min, 2, 4, 6, 12, 24, hours after deflation of tourniquet and the total dosage of pethidin injected in the first 24 hours after operation was calculated. Sensory and motor block began more rapidly in study group than control group [2.61 vs. 5.09 and 4.22 vs. 7.04 min., respectively] [p<0.05]. Recovery from sensory and motor block and onset of tourniquet pain were delayed [7.26 vs. 3.43, 9.70 vs. 3.74 and 25 vs. 16.65min., respectively] [p<0.05]. Duration of analgesia after tourniquet deflation was more prolonged and tourniquet pain intensity was lower in study group [p<0.05]. Fentanyl requirement during operation and meperidine used during first postoperative day and pain intensity at 4, 6, 12 and 24hr postoperatively were lower in study group p<0.05. No significant side effect was noted in the patients of both groups. Addition of NTG to lidocaine in intravenous regional anesthesia accelerates the onset of anesthesia and decreases the tourniquet and postoperative pain, without any side effect

Intratracheal administration of lidocaine for sedation of patients under mechanical ventilation: a double-blind randomized clinical trial

Some patients with respiratory failure who are in need of mechanical ventilation require sedation to tolerate the inserted endotracheal tube [ETT] and other unpleasant stimuli. While a light sedation is satisfactory, deep sedation can interfere with the weaning process of patient from mechanical ventilator. Nevertheless, so far, the ideal regimen for sedatives and analgesics has not been found. We evaluate the effect of intratracheal administration of lidocaine for sedation of patients under mechanical ventilation. In a double-blind randomized clinical trial, 50 patients aged 33-65 years who had no obvious brain injury, in need of mechanical ventilation were enrolled into this study. They were randomized into two groups; the treatment group received 2.5 mL of 2% lidocaine, and the control group received 2.5 mL of normal saline via ETT each two hours for 12 h under sterile conditions. The baseline sedation was maintained with morphine, midazolam, or both, which were titrated to patient comfort and to maintain an optimum sedation score throughout the entire study. During 12 h of the study, the mean +/- SD total morphine and midazolam requirements were 7.13 +/- 0.96 and 4.65 +/- 1.15 mg, respectively, in the treatment group, and 11.08 +/- 0.77 and 6.37 +/- 1.17 mg, respectively, in the control group. There was a significant [P<0.05] reduction in the requirements for both drugs during the study in the treatment group as compared to the control group. Intratracheal administration of lidocaine significantly reduces sedative requirements in intubated patients during 12 h. In the short-term, no side effects or complications were observed

[ prevalence rate of substance abuse and addiction and some relevant factors among junior and senior high school students in Kerman city [2000-2001]]

The Aim of this research was to evaluate the prevalence of addiction and its relationship with some demographic features, knowledge, behavior and attitude among junior and senior high school students in the city of Kerman. This cross-sectional study was done by using a self-made questionnaire including issues related to taking illicit drugs and demographic features. The questionnaires were distributed among 3500 students of whom 3318 [94.8%] returned the questionnaires. Data analysis was done by SPSS-10 software and using t-test, chi[2] and Odds Ratio for Trend methods. Among studied students, 58.2% were male and 41.38% were female. In males, 26.6% and in females, 11.5% had taken illicit drugs at least once. In boys the prevalence of drug abuse was as follows: alcohol 16.2%, opium 11.7%, tranquilizers 9.7%, cannabis 8.3%, anabolic androgens 8.2%, Shire [extract of opium] 7.7%, LSD 5.8%, heroin 5.5%. The prevalence in girls was as follows: opium 5.1%, alcohol 4.5%, tranquilizer 4.42%, cannabis 2.8%, anabolic androgens 2.8%, Shire 2.6%, LSD 2%, heroin 2%. As it is seen in male students the prevalence of all drugs is significantly higher comparing to female students [P<0.0001]. In other words, male students use drugs more frequently than female students [P<0.0001]. However in regard to this fact there was no significant difference based on the year of study. The desire for giving up was significantly more in boys [40%] compared to girls [27.2%]. The most preferred option for giving up was self medication. For overcoming addiction problem students had sought advice from their intimate friends, father, and mother respectively. Students believed that they had gained most of the useful information regarding addiction from school headmasters and educating [Parvareshi] teachers, while the least affecting source of information were health teachers. According to the findings, addiction in teenagers should be considered as a serious issue. As well as opioid drugs and alcohol, attention to other drugs is also required. Organized education with feedback would be helpful, and more attention should be given to the roles of educating teachers. With regard to abstinence desire, there should be more facilities to encourage drug abusers to seek help from the consultation, rehabilitation and detoxification centers

Evaluation of the effectiveness of lidocaine infusion in reduction of postoperative pain

Postoperative pain is an acute pain related to size and site of operation, patient's psychologic and physiological condition, degree of manipulation and damage of tissues. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Administration of opioids is one of the common techniques for postoperative pain management, but complications related to opioids leads to use of other methods for pain control. In this study we evaluated the effect of low dose lidocaine infusion for postoperative pain control. In this study, 30 patients were randomized in two study and control groups under similar conditions. In study group, administration of lidocaine 1% [1.5mg/kg followed by 1.5 mg/ kg /h infusion] was started 30 minutes before operation, and continued 1 hour after operation. In control group, normal saline [placebo] was used. After 24 hours, pain of patients and systemic analgesic consumption was assessed and analyzed. Results showed that infusion of low dose lidocaine does not reduce postoperative pain and amount of morphine consumption 24 hours after operation. Difference in results of this study and other similar investigations can result from difference in design and selected surgical procedures. Also, lack of medical and research equipments such as appropriate PCA [Patient Controlled Analgesia] and measurement of blood levels of lidocaine were limitations of this study

Intra - articular bupivacaine versus bupivacaine plus dexamethasone for analgesia after knee surgery

Postoperative pain is a common problem suffering the patients after knee surgery. Treatment with intra-articular corticosteroid preparation has been advocated but the value of this approach has not been established. We compared the efficacy of intra-articular dexamethasone plus bupivacaine with the efficacy of intra-articular bupivacaine alone to prevent post-operative pain after meniscectomy. Sixty ASAI patients undergoing meniscectomy with general anesthesia were randomly assigned to receive intra-operative intra-articular bupivacaine, bupivacaine plus dexamethasone, or placebo under double blinded condition. The group 1 [n=20] received 10ml of bupivacaine 0.5% with epinephrine 1 :2000000, group 2 [n=20] received 8ml bupivacaine 0.5% with epinephrine 1 :200000 plus 2ml [8mg] dexamethasone and group 3 [n=20] received 10ml of normal saline. The patients were evaluated until 12 hours after the operation and pain levels at rest measured by a Visual Analogue Scale [VAS]. During the first six hours after the operation, both combination of bupivacaine and dexamethasone and bupivacaine alone significantly reduced patient's pain [P=0.000] and during six to twelve hours after operation the patients in dexamethasone group had significantly lower pain scores comparing to the other group [P=0.037]. The low pain scores were associated with lower requirement of supplementary analgesics [P=0.000]. Combination of intra-articular dexamethasone and bupivacaine significantly reduces post-operative pain and consumption of analgesics following meniscectomy than intra-articular bupivacaine alone

High intravenous fluid therapy prevents post-tonsillectomy nausea and vomiting

Background: post-operative nausea and vomiting [PONV] following surgical operations requiring general anesthesia are common and distressing. The incidence of PONV may be as high as 70% during the first 24 hrs. of tonsillectomy

Objective: this study determines the effects of intraoperative well-hydration on postoperative nausea and vomiting

Methods: 90 ASA I patients with age of 6-12 years scheduled for tonsillectomy under general anesthesia randomly assigned to receive either routine iv fluid plus intraoperative well-hydration plus 4 ml/kg/h Ringer's solution [well hydrated group; n=45] and routine iv fluid requirements [control group; n=45]. All study preparations were administered in a double blinded fashion

Results: during the first postoperative day, the incidence of nausea and vomiting were significantly lower in the well-hydrated group as compared with control [p<0.05]. There was no significant differences between males and females regarding the incidence of nausea and vomiting [p>0.05]

Conclusion: the present study showed that well-hydration reduces the incidence of post tonsillectomy nausea and vomiting, and high iv fluid therapy is a simple, effective, safe and well-tolerated technique for prevention of postoperative nausea and vomiting