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November 2017 -
Volume 15, Issue 9

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From the Editor

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Original contribution/Clinical Investigation
Diabetes Mellitus - Knowledge, Management and Complications: Survey report from Faisalabad-Pakistan
Ijaz Anwer, Ahmad Shahzad, Kashmira Nanji, Farah Haider, Muhammad Masood Ahmad

Alanine aminotransferase indicates excess weight and dyslipidemia
Mehmet Rami Helvaci, Orhan Ayyildiz* Mustafa Cem Algin, Yusuf Aydin, Abdulrazak Abyad, Lesley Pocock

Comparative Analysis of Antimicrobial Peptides Gene Expression in Susceptible/Resistant Mice Macrophages to Leishmania major Infection

Hamid Daneshvar, Iraj Sharifi, Alireza Kyhani, Amir Tavakoli Kareshk, Arash Asadi

Does socio-economic status of the patients have effect on clinical outcomes after coronary artery bypass grafting surgery?
Forough Razmjooei, Afshin Mansourian, Saeed Kouhpyma

Comparison of the uterine artery Doppler indices during pregnancy between gestational diabetes and diabetes mellitus and healthy pregnant women
Nazanin Farshchian, Farhad Naleini, Amir Masoud Jaafarnejhad,
Parisa Bahrami Kamangar

Survey single dose Gentamicin in treatment of UTI in children with range of 1 month to 13 years old in Jahrom during 2015
Ehsan Rahmanian, Farideh Mogharab,
Vahid Mogharab

Evaluation of control of bleeding by electro cauterization of bleeding points of amplatz sheath tract after percutaneous nephrolithotomy (PCNL) in Jahrom Peymanieh hospital during year 2015-2016
Ali Reza Yousefi , Reza Inaloo

Comparison of the three-finger tracheal palpation technique with triple ID formula to determine endotracheal tube depth in children 2-8 years in 2016-2017
Anahid Maleki, Alireza Ebrahim Soltani, Alireza Takzare, Ebrahim Espahbodi,
Mehrdad Goodarzi , Roya Noori

Effect of Sevoflurane and Propofol on pulmonary arterial pressure during cardiac catheterization in children with congenital heart diseases
Faranak Behnaz, Mahshid Ghasemi , Gholamreza Mohseni, Azim Zaraki
Population and Community Studies

Prevalence and risk factors of obesity in children aged 2-12 years in the Abu Dhabi Islands
Eideh Al-Shehhi, Hessa Al-Dhefairi, Kholoud Abuasi, Noora Al Ali, Mona Al Tunaiji, Ebtihal Darwish

Study and comparison of psychological disorders in normal students and students with multiple sclerosis in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani

Comparative study of self-concept, physical self-concept, and time perspective between the students with multiple sclerosis and healthy students in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani

Relationship between Coping Styles and Religious Orientation with Mental Health in the Students of the Nursing-Midwifery Faculty of Zabol
Nasim Dastras, Mohsen Heidari Mokarrar, Majid Dastras, Shirzad Arianmehr

Tuberculosis in Abadan, Iran (2012-2016): An Epidemiological Study
Ali-Asghar ValiPour, Azimeh Karimyan, Mahmood Banarimehr, Marzieh Ghassemi, Maryam Robeyhavi, Rahil Hojjati,
Parvin Gholizadeh

Family Stability and Conflict of Spiritual Beliefs and Superstitions among Yazdi People in Iran: A Qualitative Study
Zahra Pourmovahed , Seyed Saied Mazloomy Mahmoodabad ; Hassan Zareei Mahmoodabadi ; Hossein Tavangar ; Seyed Mojtaba Yassini Ardekani ; Ali Akbar Vaezi

A comparative study of the self-actualization in psychology and Islam
Simin Afrasibi, Zakieh Fattahi

The effectiveness of cognitive - behavioral therapy in reducing the post-traumatic stress symptoms in male students survivors of earthquake in the central district of Varzeghan
Sakineh Salamat, Dr.Ahad Ahangar, Robab Farajzadeh

Reviews

Effects and mechanisms of medicinal plants on stress hormone (cortisol): A systematic review
Kamal Solati, Saeid Heidari-Soureshjani, Lesley Pocock

Comparing Traditional and medical treatments for constipation : A Review Article
Mohammad Yaqub Rajput

A review of anti-measles and anti-rubella antibodies in 15- 25 year old women in Jahrom City in 2011
Ehsan Rahmania , Farideh Mogharab, Vahid Mogharab

Review of percutaneous nephrolithotomy in children below 12 years old in Jahrom hospital, during 2010-2014
Ali Reza Yousefi , Reza Inaloo

Physical and mental health in Islam
Bahador Mehraki, Abdollah Gholami

International Health Affairs

The Challenges of Implementation of Professional Ethics Standards in Clinical Care from the viewpoint of Nursing Students and Nurses
Saeedeh Elhami, Kambiz Saberi, Maryam Ban, Sajedeh Mousaviasl, Nasim Hatefi Moadab, Marzieh Ghassemi

Cognitive Determinants of Physical Activity Intention among Iranian Nurses: An Application of Integrative Model of Behavior Prediction
Arsalan Ghaderi, Firoozeh Mostafavi, Behzad Mahaki, Abdorrahim Afkhamzadeh,
Yadolah Zarezadeh , Erfan Sadeghi

Effect of resilience-based intervention on occupational stress among nurses
Hossein Jafarizadeh, Ebrahim Zhiyani, Nader Aghakhani, Vahid Alinejad, Yaser Moradi

Education and Training

Calculation of Salaries and Benefits of Faculty Members in the Ministry of Health and Medical Education of Iran
Abdolreza Gilavand

The effect of education on self-care behaviors of gastrointestinal side effects on patients undergoing chemotherapy
Shokoh Varaei, Ehsan Abadi Pishe, Shadan Pedram Razie, Lila Nezam Abadi Farahani

Creating and Validating the Faith Inventory for Students at Islamic Azad University of Ahvaz
Solmaz Choheili, Reza Pasha, Gholam Hossein Maktabi, Ehsan Moheb

Creating and Validating the Adjustment Inventory for the Students of Islamic Azad University of Ahvaz
Homa Choheili, Reza Pasha, Gholam Hossein Maktabi, Ehsan Moheb

Evaluating the Quality of Educational Services from the Viewpoints of Radiology Students of Ahvaz Jundishapur University of Medical Sciences
Abdolreza Gilavand, Jafar Fatahiasl

An Investigation of Psychosocial aspect of Iranian Nursing Students' Clinical Setting
Mahsa Boozaripour , Zanyar Karimi, Sima Zohari Anbohi, Amir Almasi-Hashiani, Fariba Borhani

Clinical Research and Methods

Comparison of the Antibacterial Effects of Chlorhexidine Mouth washes with Jaftex Mouth wash on Some Common Oral Microorganisms (An in Vitro Study)
Ebrahim Babadi, Zahra Bamzadeh, Fatemeh Babadi

Study of the effect of plasma jet on Fusarium isolates with ability to produce DON toxins
Elham Galin Abbasian, Mansour Bayat, Arash chaichi Nosrati, Seyed Jamal Hashemi, Mahmood Ghoranneviss

The comparison of anti-inflammatory effect in two methods of topical dexamethasone injection and topical application of ginger alcoholic extract after removing mandibular wisdom teeth
Sahar Zandi, Seyyed Muhammadreza Alavi, Kamran Mirzaie, Ramin Seyedian, Narges Aria, Saman Jokar

The effect of curcumin on growth and adherence of major microorganisms causing tooth decay
Leila Helalat, Ahmad Zarejavid, Alireza Ekrami, Mohammd Hosein Haghighizadeh, Mehdi Shiri Nasab


Middle East Quality Improvement Program
(MEQUIP QI&CPD)

Chief Editor -
Abdulrazak Abyad MD, MPH, MBA, AGSF, AFCHSE

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Lesley Pocock
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November 2017 - Volume 15, Issue 9

The effect of education on self-care behaviors of gastrointestinal side effects on patients undergoing chemotherapy


Shokoh Varaei (1)
Ehsan Abadi Pishe (2)
Shadan Pedram Razie (3)
Lila Nezam Abadi Farahani (4)

(1) Ph.D. in Nursing, Assistant Professor of Internal Medicine Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
(2) MSc Student, Internal- Surgery nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Iran
(3) Master of Science (MSc) in Nursing, Faculty Member, Department of Nursing and Midwifery, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
(4) Master of Science in Biomedical Science

Corresponding author:
Ehsan Abadi Pishe
MSc Student, Internal-Surgery nursing, Faculty of Nursing and Midwifery,
Tehran University of Medical Sciences, Iran
Email: ehsanabadipishe@yahoo.com

Abstract

Background and Objectives:
Cancer is a deadly disease of humanity. One of the main curative options is the use of chemotherapy treatments. From 40 to 80 percent of chemotherapy treatment can cause complications such as nausea and vomiting, mouth sores and disorders of the bowel. The aim of this study was to evaluate the effect of education on self-care behaviors on gastrointestinal side effects in patients undergoing chemotherapy.

Methodology: This study is a randomized clinical trial of 60 women with breast cancer undergoing chemotherapy who were referred to Chamran hospital chemotherapy center. Prior to chemotherapy and after obtaining the consent for the random sampling method, patients were divided into two groups, intervention and controls. Patients in the intervention group received routine treatment to improve the side effects of chemotherapy, in the form of self-care training received from the researcher. Data was collected by a demographic questionnaire, a questionnaire on side effects of chemotherapy questionnaire and Morrow standard questionnaires were collected. Data using descriptive and inferential statistics were analysed by SPSS¬¬¬v21 software.

Results: The results showed that the use of self-care education to reduce mouth sores was statistically significant (p <0.05). Self-care training also leads to a reduction in frequency and severity of nausea and vomiting in patients. This reduction was statistically significant (p <0.05).

Conclusion: Findings of the study showed that the use of self-care training alongside drug regimen reduces the side effects of chemotherapy in patients. Therefore, it is recommended that nurses use this technique as a complementary method to reduce side effects of chemotherapy.

Key words: self-care, side effects of chemotherapy, chemotherapy, nurses


INTRODUCTION

Cancer can be considered as one of the most dangerous diseases that affects humanity. Cancer often can be considered on equal terms with death, disfigurement and dependency (1). Cancer is a global problem that affects people regardless of age, race, and socioeconomic status. Cancer annually kills about 552,200 people worldwide (2). Treatment of cancer is complex, and includes surgery, radiation and chemotherapy, which may be combined or used separately. The most common treatment is the use of chemotherapy (3). Today, with the increasing development of medical science and pharmacy and chemotherapy, drugs have been able to greatly reduce cancer mortality and increase life expectancy in patients (4). A variety of chemotherapy regimens that are moderate to severe, can cause complications such as nausea, vomiting, bowel disorders and mouth ulcers in patients. Generally, 40 to 80 percent of patients suffer from side effects of chemotherapy. These complications cause water and electrolyte disorders, weakness and fatigue, decreased immunity, and bacterial and fungal infections can occur throughout the body (5). The severity of side effects of chemotherapy varies from person to person. Side effects in some patients, may be so severe as to cause the withdrawal of the patients’ treatment (6). Other patients also have disrupted social role, withdrawal from society, physical dysfunction and depression. Therefore, it is vital that the side effects of chemotherapy in cancer patients are reduced (7).

To reduce side effects of chemotherapy in patients serotonin receptor antagonist drugs, corticosteroids, metoclopramide, laxative and industrial mouthwash have been used (8). Research has shown that in 50% of cases complications arising from chemotherapy in patients with drug use has been observed (9, 10). On the other hand, these medications are associated with increased healthcare costs and side effects such as extrapyramidal side effects, fatigue, drowsiness, hypotension, headache, increased dry mouth, and restlessness and side effects may limit the medication (8). Studies have shown that drug treatment reduces side effects of chemotherapy in patients. But the full effects are not eliminated therefore the use of non-pharmacological methods with medical methods to reduce side effects of chemotherapy in patients has been proposed. A variety of non-pharmacological methods of traditional medicine, relaxation techniques such as yoga, hypnosis and acupuncture can be named (11).

One of the non-medicinal methods to reduce side effects of chemotherapy is the use of self-care. The self-care theory of Dorothea Orem, a famous theoretician is one of the most common theories in the field of clinical nurses and nursing students used by researchers (12). In his theory of self-care, the patient needs assessment is done and the needs of patients in order to reduce the side effects of chemotherapy are determined. Then oncologists and specialist nurses of chemotherapy are trained according to the latest guidelines published by the National Cancer Institute (13). The ability to find patient care in the absence of health centers and when there is no access to these centers to reduce the side effects of chemotherapy is a major concern. This incurs possible increased medical expenses and decreased access to health centers (14). In studies on self-care, especially its impact on chronic diseases, it has been shown that the effects of self-care in patients have been less reported (15, 16). Less studies about self-care and its impact on the reduction of side effects of chemotherapy is taken. Therefore, further research in this area appears evident. On the other hand, nurses as one of the most important health team members who are in direct contact with patients could be involved in teaching this as one of the most important tasks for such patients. Nurses with such training can be more effective and provide tips and a more sustainable model of care to patients (17). According to the above the purpose of this study was to evaluate the effect of self-care behaviors of gastrointestinal side effects in patients undergoing chemotherapy.

MATERIALS AND METHODS

This study is a randomized clinical trial (18) that was conducted in Chamran hospital chemotherapy centers between January 2016 to May 2017. A sample using the following formula and 95% confidence and 90% power and using the results of studies that had been done in this area (19) in each group of 30 was determined.

Sampling method was available and samples divided randomly into two groups of intervention and controls were allocated.

Inclusion criteria included in the study were over 18 years of age, a definite diagnosis of breast cancer by a physician, oncology, ability to read and to write and lack of medical and paramedical subjects in groups and not receiving formal training and previous self-care and for relieving the side effects of chemotherapy, a regimen of moderate to severe chemotherapy, the use of drugs other than drugs prescribed by a physician, lack of digestive diseases, kidney disease, liver failure, gastrointestinal tract obstruction. On the other hand, those who do not wish to continue participating in the study were excluded.

The instrument used in this two-part study of demographic and inventory side effects of chemotherapy by ten members of the university of Medical Sciences of Tehran board was examined for its validity and reliability and was confirmed was the standardized questionnaire of Morrow (1984), which has 18 questions about side effects of nausea and vomiting. We assessed the validity and reliability of the various studies and the correlation value of R = 0.72-0.96 was reported (20).

After obtaining confirmation from the ethics committee of Tehran University of Medical Sciences s permission was granted with 9311698006 code and IR.TUMS.FNM.REC.1395.1637 with reference to the above chemotherapy hospitals, among women with breast cancer who met the inclusion criteria after explaining the purpose of the study and obtaining informed consent from patients to participate in the study sample.

The Morrow questionnaire and chemotherapy questionnaire were used before initiation of chemotherapy, and the side effects of chemotherapy patients in the intervention group and the control group were recorded. Patients in both groups were informed that Morrow questionnaire was to be completed in the first three days after discharge from the hospital every night and at a specified time and on the third day to complete the questionnaire on side effects of chemotherapy. After patients received chemotherapy in the first period when the questionnaires were taken then patients in the intervention group, at two sessions for 20 minuteswere taught face to face. It should be noted that both groups benefits from treatment were routine. The patients in both groups after the end of chemotherapy were re-assessed Morrow questionnaires and the side effects of chemotherapy were recorded and the patients were asked in the first three days after discharge to complete questionnaires every night. In the intervention group a pamphlet based on the most serious patients were put at the disposal of the National Cancer Institute guidelines. After collecting the questionnaires, the data using descriptive statistics such as mean and standard deviation and inferential statistics, including t-test and chi-square and software SPSS genes and were analyzed. A significance level of P <0.05 was considered

FINDINGS

The sample participating in the study included 60 patients with breast cancer who met the inclusion criteria. Demographic and clinical characteristics of both groups included age, smoking history, alcohol, opium drug use, number of sessions of chemotherapy and mastectomy, which is presented in Table 1 and 2. In surveys conducted in terms of the numbers of patients in the control group and the experimental group in terms of demographic characteristics were homogeneous.

The results showed that patients in the intervention group who had undergone training in self-care behavior compared to the control group patients, complained less of stomatitis and mouth ulcers. That’s why the intervention effect of the change in the mean indices before and after the intervention and control groups was used. In the intervention group it reduced on average by 6.63 units of stomatitis and in the control group increased by an average of 0.76 units. The changes were not statistically significantly different between the two groups (Table 3 - page 168).

The results showed that the patients are prepared for the effects of fecal excretion rate of complications in the intervention group increased at a rate of 2.36 units. This control declined by 1.03 unit. These results were also statistically significant (Table 3).

The results showed that patients in the intervention group had less occurrence and severity of nausea than patients in the control group. These results are statistically significant (Table 3).
The severity and vomiting in patients in the intervention group were less likely to complain of side effects and these results were also statistically significant (Table 3).

Click here for Table 1: Compared and related demographic data of the sample of women with breast cancer who referred to Chamran Hospital in 2016-17

Click here for Table 2: Compared and related demographic data of the sample of women with breast cancer who referred to Chamran Hospital in 2016-17

Click here for Table 3

DISCUSSION AND CONCLUSION

This study aimed to investigate the effect of self-care education on complications of chemotherapy. The results showed that the effects of stomatitis and complications associated with nausea and vomiting in patients in the intervention group compared to the control group of patients decreased significantly. In this regard Karbaschi et al in their study reached the same conclusion that stated the patients who were under the self-care of the side effects of chemotherapy had a better quality of life (21). Masoudi et al’s study results are consistent with results in 8 sessions of a self-care program based on the needs of patients for patients considered to be based on self-care training was conducted for patients. Patients before the study in terms of quality of life in the intervention group and the control group differed significantly but after the tasks involved, those in the intervention group scored better quality of life than patients in the control group reported (22).

Golchin et al. achieved similar results. Demographic variables of patients were similar but regarding the presence of side effects of chemotherapy, there was no communication with each other. After training patients in the intervention group more than the control group patients, had better quality of life. The design and implementation of training programs was based on the training needs of patients as well as the extensive care-self program outlined in this study had been proposed (23).

The results of this study showed that nausea, and its frequency and severity in the intervention group after execution of training required receiving less care than patients in the control group. The results of the study were consistent with Karbaschi et al’s results (21). Similar results were obtained in the study of Williams and Sherir. This means that education about self-care by nurses often reduces nausea in patients and patients who were admitted to this training had better quality of life (14). The results of this study showed that patients who had