Mami Onishi

Relationship between nursing care delivery system and nurses’ perceptions of their work

Background and purpose: Using practical and non-invasive methods to improve the adequacy of dialysis (i.e. Kt/V) can increase the quality of life and decrease the mortality and morbidity rate in patients under hemodialysis. This study was conducted to investigate the effect of intermittent normal saline bolus on adequacy of dialysis. Materials and methods: In this randomized controlled cross-over clinical trial, 51 patients were chosen based on inclusion criteria and were randomly assigned into two groups. Before the intervention, the Kt/V and Urea Reduction Ratio (URR) of the last session of dialysis (baseline) were measured in all patients. The control group were dialyzed conventionally (heparinized dialysis), but the intervention group received 100 ml normal saline bolus every hour, within three times. In three subsequent sessions, as a washout period, all patients received conventional hemodialysis. Then the patients were swapped and all steps were repeated. Results: Before the intervention, there were no significant differences between the two groups in age, sex, duration of dialysis, type of vascular access, adequacy of dialysis, and Urea Reduction Ratio (P>0.05). Compared with baseline, the Kt/V and URR mean values increased by 16 and 8% in intervention group, respectively (P<0.01) but these values decreased in control group. In addition, findings revealed significant differences in Kt/V and URR mean values between the two groups after using normal saline bolus intermittently (P< 0.01). Conclusion: Using intermittent normal saline bolus during hemodialysis improves adequacy of dialysis.H impairment is one of the most common sensory deficits in human communities. Recent studies have shown that presbycusis happens earlier than before. Hearing loss due to the aging process or presbycusis, can cause inability to interpret sounds in speech, decreased ability to communicate and withdrew from society. Therefore these factors may lead to psychological problems such as depression. Since there are few studies evaluating the side effects of presbycusis in Iran, we started the study of depression in presbycusis clients referred to the audiology clinics of Isfahan University of Medical Sciences, Isfahan, Iran. In this crosssectional study, the relationship between demographic characteristics and depression was determined. In order to collect information and evaluate depression, Beck Depression Inventory-II (BDI-II) was utilized and conducted on 35 cases. Results indicated that 8.6% had minimal depression, 14.3% with mild, 20.0% moderate depression and 57.1% had severe depression. No significant correlation between age, gender and depression was achieved. Using depression questionnaire such as BDI-II during aural rehabilitation process could be valuable. More complications were found in acceptance of hearing aids in elderly people with depression. Psychological treatment can be suitable while audiological management was accomplished simultaneously for this group.Results: Data analysis extracted the theme of loyalty as the main strategy of pediatric nurses during drug administration. The main category of loyalty was divided into eight subcategories: Principled drug administration, double-checking for high alert drugs, reminders to physicians, seeking drug information, supervision of novice nurses, follow-up and resolving of drug shortages, removing difficulties in pediatric drug administration, application of professional experience.