The level of knowledge regarding VAP prevention seems inadequate in the present study. Although having knowledge about the principles of evidence-based care cannot guarantee the implementation of these principles, lack of knowledge may be a potential barrier to adherence to evidence-based guidelines for the prevention of VAP. This article is protected by copyright. All rights reserved.

Background Coronary angiography is used as a qualified method to diagnose coronary heart disease. However, patients undergoing coronary angiography experience a great deal of anxiety. The present study is aimed at investigating the effect of virtual reality on anxiety before coronary angiography. In a randomized controlled trial, 60 candidates for coronary angiography were randomly assigned to two intervention and control groups from April to July 2019. Data were collected by Spielberger’s situational anxiety questionnaire. The participants’ anxiety level and their heart rate, respiratory rate, and blood pressure were measured before and immediately after the intervention. The Intervention group received virtual reality intervention, and the control group was cared for based on the hospital routine. Data were entered into the SPSS version 24.0 software (SPSS Inc.) and analyzed using Chi-square, Paired samples, and independent sample t tests. Results The majority of participants were male (71.25%) and the Mean ± SD age of them in the intervention and control groups was 50.95 ± 4.120 and 52.08 ± 4.002 years, respectively. The mean score of anxiety (p < 0.01), heart rate (p = 0.001), and systolic blood pressure (p = 0.016) after the intervention in the intervention group decreased significantly. Conclusions This study indicated the implementation of a VR distraction protocol in the patients could effectively reduce perioperative anxiety and its indices. It showed that VR is a safe method without any complications related to the device and with good acceptability. Registration code IRCT201 40515017693N3.

Background & Aim: Professional autonomy is a key component of decision-making and empowerment of the nurses. However, ICU nurses sometimes experience a degree of moral distress in their decision-making but the relationship of this distress with their autonomous performance in intensive care units is unclear. The aim of this study is determining the relationship between professional autonomy and moral distress of ICU nurses. Methods & Materials: In this correlational cross-sectional study, 180 ICU nurses were selected by census method from educational hospitals of Guilan University of Medical Sciences in 2017. Research tools were Varjuss professional autonomy and Corely et al. moral distress questionnaires. Data were analyzed using SPSS software version 16. Results: Most of the subjects were female (93.89%), full-time nurses (61.67%), with age mean and standard deviation of 35±5.97. Mean and standard deviation of professional autonomy and moral distress were 77.04±4 and 140.85±5.45, respectively. Moral distress of most nurses (55.6%) was moderate. There was a positive and significant correlation between professional autonomy and moral distress scores (p<0.001, r=0.33). Conclusion: This study showed that by increasing the professional autonomy, the moral distress of ICU nurses increases as well. These results, by informing nursing mangers, remind the necessity of using some approaches for reducing the moral distress of nurses along with improving their professional autonomy.

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Background: Brain injury can reduce consciousness and the ability to respond to environmental stimulation. Objectives: The aim of this study was to investigate the effects of familiar voices on the level of consciousness (LOC) among comatose patients with a brain injury hospitalized in the intensive care unit. Methods: In this randomized controlled trial, sixty comatose patients with head trauma were conveniently selected from an intensive care unit of a hospital in Rasht, Iran, and randomly allocated to either a control or an intervention group. Participants in the intervention group received auditory stimulation for three consecutive days and the level of consciousness was compared in two groups. The Glasgow Coma Scale was used to assess the patients’ level of consciousness. The data were analyzed through the Chi-square, the paired-samples t, student’s t test, and the repeated-measures analysis of variance.  Results: A significant increase was found in the mean LOC in the intervention group after every daily auditory stimulation (P<0.05). However, no significant changes were observed in the control group (P>0.05). The repeated-measures analysis of variance revealed that the time and interaction of time and groups were statistically significant (P<0.001). Conclusion: Auditory stimulation with familiar voice was effective in improving levels of consciousness among comatose patients with a brain injury after three days.

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Introduction: Stroke is the most common cerebrovascular disease and the third most common cause of disability in the world. The study aimed to assess the knowledge of nurses in emergency departments based on evidence-based care guidelines in the acute phase of ischemic stroke. Methods: This cross-sectional analytical study was performed on 129 nurses working in emergency departments of 16 hospitals of Guilan University of Medical Sciences in 2017. Samples were selected randomly. The study tool was a questionnaire with 10 multiple choice questions about the care of acute phase of ischemic stroke patients. Data were analyzed by SPSS software ver. 21 using descriptive tests, ANOVA, T-test, Chi-square. Results: The mean of the participants’ knowledge about acute phase of ischemic stroke care was 40.07 ± 16.46. The highest response rate was related to the symptoms of stroke (85.27%). There was a significant relationship between the number of beds in the hospitals and the nurses' knowledge about beginning treatment of Tissue Plasminogen Activator (tPA) (P<0.005), optimal level of blood pressure prior to administering intravenous tPA (P<0.001), and recommended dosage of tPA (P<0.001) .Also, a significant relationship was reported between the number of beds in the emergency departments and the nurses' knowledge about optimal level of blood pressure prior to administering intravenous tPA (P<0.001), and recommended dosage of tPA (P<0.001). Conclusion: The nurses' knowledge was not satisfactory about the guideline of the acute stage of ischemic stroke. Therefore, provision of evidence-based continuing education courses and mandatory attendance of emergency nurses in these courses is recommended.