[Investigation of International Pain Management Standards and Suggestion of Appropriate Standard for Iran in 2005]

There should be a simple, standard, dynamic and scientific method for improving the quality of services in every organization and all of the employees should be trained about it. A standard method first helps to learn based on practice, and second, as a common language. It simplifis cooperation, makes harmony between people and teams and provides the background of creativity and innovation. Pain management standardization has several advantages. It helps appropriate treatment of pain resulting in faster clinical recovery, shorter admission days and better quality of life. Pain management standardization is a common and unique language cousing a unison in works and correct circulation of information and preventing waste of time. This research is a triangulation study conducted based on Delphi method in 2005. The research samples, in the first stage, included 14 and in the second stage, 40 nursing faculty members who were instructors of nursing department with master's and Ph.D degrees. In this research, in the stage, pain management standards were extracted by searchin in the Intenet, valid nursing textbooks and through consulting with the instructors. In the second stage, these standards were sent for 14 nursing faculty members of Shiraz, Isfahan and Yasouj universities in the of a questionnaire with open ended questions to collct their opinions. Then according to the colleced data from second stage of the research, a new questionnaire was made. In the third stage, the questionnaire was sent for 40 nursing faculty memers of Shiraz, Isfahan, Iran, Tehran, Shahid beheshti, Masshad and Yasouj universities to collect their opinions and in the forth stage, analysis of the answers of the nursing faculty members was done. The findings of this study included two distinct areas and 88 suggested standards. The first area, assessments of pain, included 35 standards and the second area, standards with 90% consensus including 14 items in the area of assessment and implementation of pain have been suggested to decrease the number of standards in order to increase the probability of the executive power of them. Pain management suggested standards made by this study are 88 items. It is hoped that these suggested Pain management standards can promote the quality of pan management, improve the quality of hospital services and increase patients' statisfaction

[Effects of outside bed elimination on physical and psychological reaction of the patients with CAD]

Introduction: This is a quasi-experimental study focussing on defining the effect of outside bed elimination on psychological and physical reaction of coronary patients in CCUs selected in hospitals of social security organization in 2002

Methods: This is a two group two stage survey carried out on all coronary patients hospitalized in CCU of Dr. Shariati hospital, well qualified to enter the study, selected through non randomized convenient sampling. The samples were randomly devided into two groups of study and control. The data were collected by interviews and observations through questionnaires, sphygomomanometer and tele cardiac monitoring. The questionnaire including four sections was made according to scientific books and articles. The first section, filled at the begining of the research, included nine questions on individual and health related characteristics. The second included five questions on urination and defecation status and the third contained eight questions oil and defecation signs. The fourth was composed of an anxiety and depression hospital questionnaire including fourteen questions. Scientific validity of the questionnaire was made by content validity and the reliability was made through a pilot study with a korenbach of 90%. All the subjects were in complete bed rest for the first 12 hrs and had in bed elimination. As soon as outside bed eliminations was licensed, Bp and heart rate were checked for study group before elimination and in case of arrhythmia, it was recorded. Elimination signs were asked from the subjects and recorded. Bp, heart rate, arrhythmia and elimination signs were recorded after elimination. For controls, elimination was administrated handling a bedpan and in bed after interviewing and filling the questionnair without any further researchers' interventions. The data were processed and analyzed by SPSS and inferential descriptive statistics. Pair t-test, T-test, Wilcoxon and Manwhitney tests were used to reach the goals of the study

Results: The findings showed that there was a significant difference between mean BP and heart rate before and after elimination in bed and out of bed [P=%001].Mean systolic BP and heart rate showed a significant difference between, before and after elimination out of bed compared with controls [P>%05]. The findings concerning frequency distribution of the signs before and after elimination out of bed also showed no significant difference with the controls [P>%05]. Frequency distribution of arrhythmia after elimination out of bed showed a significant difference with controls [P0/004]. Mean number of eliminations after elimination out of bed showed a significant difference with controls [P=0/001]. Regarding the frequency distribution of the subjects in study and control groups concerning psychological reaction, there was a significant difference before and after eliminations in and out of bed [P=0/001]. The findings also showed no significant difference in the frequency distribution of the subjects according to psychological reactions before elimination out of bed while there was a significant difference after elimination out of bed [P=0/023]

Discussion: This study recommends applying its findings in different fields of nursing and suggests further studies in this field Out of bed elimination in patients with CAD in CCU is safe and affects patients' physical and psychological reactions