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Background: Non-pharmacological pain management in patients receiving mechanical ventilation support in critical care units is under-investigated. Natural sounds may help reduce the potentially harmful effects of anxiety and pain in hospitalized patients.Aims: This article examines the effect of pleasant, natural sounds on self-reported pain in patients receiving mechanical ventilation support.Design: A pragmatic parallel arm randomised controlled trial. Settings:A general adult ICU of a high turnover teaching hospital, Tehran, Iran. Participants/Subjects: Sixty patients receiving mechanical ventilation supportMethods: Between Oct 2011 and June 2012, we recruited sixty patients receiving mechanical ventilation support to intervention (n=30), and control arms (n=30) of a pragmatic parallel group randomized controlled trial. Participants in both arms wore headphones for 90 minutes. Those in the intervention arm heard pleasant natural sounds, while those in the control arm heard nothing.Outcome measures included the self-reported Visual Analog Scale (VAS) for pain at baseline, and 30, 60, 90 minutes into the intervention and 30 minutes after the intervention.Results: All those approached agreed to participate. The trial arms were similar at baseline. In the intervention arm, pain scores fell and were significantly lower than in the control arm at each time point (p < 0. 05). Conclusions:Administration of pleasant natural sounds via headphones is a simple, safe, nonpharmacologic nursing intervention that may be used to allay pain for up to 120 minutes in patients receiving mechanical ventilation support.Key words: mechanical ventilation, nurse, nursing, pain, randomised controlled trial, sounds. 2 BackgroundPain is the fifth vital sign. Its management is central to the care of critically ill patients, but is sometimes misunderstood and poorly executed by nurses (Aslan et al. 2003, Summer & Puntillo et al. 2001, Shannon & Bucknall 2003, Higgins et al. 2004, Gélinas et al. 2004, Gélinas et al. 2006. Pain is frequently a barrier to caring, haemodynamic stability and healing (Cullen et al. 2001).The need for mechanical ventilation, to maintain adequate oxygenation and protect the airway, is one of the principal reasons for admission to Intensive Care Units (ICUs). Many medical conditions, critical illnesses and critical care procedures, such as intubation, suction, immobilization, repositioning, and invasive monitoring evoke pain (Stanik-Hutt 2003, Kwekkeboom & Herr 2001. Respiratory distress, hypoxemia, and mechanical ventilation, particularly the presence of endotracheal tubes and airway suctioning, may also induce anxiety, in addition to pain and discomfort (Tracy & Chlan 2011, Nelson et al. 2004, Costa et al. 2006, Pun & Dunn 2007. Therefore, provision of adequate care to mechanically ventilated patients usually entails administration of opioids not only to decrease pain and discomfort, but also tominimize the anxiety, tachypnoea and hypertension associated with the unpleasant experiences of endotracheal...

Introduction and Aim:The assessment of self-esteem in hemodialysis people is becoming increasingly important and necessary. Low self-esteem as a problem in patients undergoing hemodialysis decreases adherence to treatment. The researcher intends to carry out a study in order to investigate the effect of self-care education on enhancement of the self-esteem of patients undergoing hemodialysis in Iran.Method and material:This is a quasi-experimental study. The subjects of the study who were selected based on purposive sampling method consisted of 50 patients with advanced chronic renal disease treated with hemodialysis. Before the intervention, two questionnaires were completed by patients. There was no intervention in the control group and the patients received only routine care in the hospital. In the experimental group, the hemodialysis patients received 5 consecutive one-hour training sessions by the researcher. Then the Rosenberg scale was filled out by the patients 2 month later.Result:According to the results, Paired t-test showed a significant difference between the mean self-esteem score in both groups before and after intervention.Conclusion:Increasing the knowledge and awareness of hemodialysis patients must constitute a cornerstone of therapy and an integral part of nursing responsibilities. Nurses should educate the patients about self-care behaviors and remind them of the dangerous complications of abandoning these.