نشریه پرستاری مراقبت ویژه
سال نهم شماره 1 (پیاپی 29، 2016 Feb)

In dealing with the new challenges of the health system, the head nurses of intensive care units need continuing educational programs, and investigating the learning requirements is the infrastructure of developing human resources.
This study aimed to assess the educational needs of the head nurses of intensive care units.
This qualitative study was conducted during year 2014. Data collection was done through semi-structured and in-depth face-to-face interviews with ten head nurses of the intensive care units of hospitals located in Mazandaran province. Data analysis was carried out with the conventional method of qualitative content analysis.
After data analysis and extraction of 300 primary codes, 21 categories and four main themes were identified. The themes included “scientific needs”, “artistic needs”, “technical needs” and “organizational needs”, which partially overlapped.
The data of this study showed that for obtaining managerial competence in these units, the head nurses of intensive care units need some instructions to satisfy their scientific, artistic, technical and organizational needs. Proper planning and implementation of continuous in-service education based on these training requirements paves the way for providing hospitals with nurses competent for managing the intensive care units.

One of the methods for achieving vascular access in hemodialysis patients is using cuffed hemodialysis catheters (permi-cath), which has some risks such as infection. Staphylococcus is the most common microorganism that causes permi-cath infection, and has contaminated 90% of clinical staff.
This study aimed to determine some strategies to reduce the level of permi-cath infection in hemodialysis patients.
Patients and This was an action research, conducted on 32 patients with permi-cath, 21 of whom had acquired this infection in the past six months. The subjects were selected through convenient sampling. The required data were collected by observations, interviews and using the data documented in the patients’ medical files as well as a questionnaire. The etiological factors of permi-cath infection were investigated; the strategies were determined through staffs’ participation and using a standard guideline. Economical strategies were administrated based on their priority and applicability.
Twenty-five (65 %) patients received antibiotics (vancomycin); this number decreased to one (4.6%) after the intervention. Fourteen (44 %) were hospitalized before the intervention; this also decreased to zero after the intervention. Therefore, there was a statistically significant difference between the number of patients taking antibiotics before and after the intervention.
Action research is an appropriate method for changing and improving nurses’ practice. Since staffs’ viewpoints are considered in this method, it makes them accept the required changes more rapidly. In addition, the decisions that are made will be more stable.

Sleep disorder is a common problem in patients hospitalized in cardiac care unit (CCU) and it may lead to irreversible consequences. Evaluating sleep quality is an important indicator in care quality. A new method to improve quality of nurses’ clinical practice is implementation of evidence-based nursing guidelines.
This study aimed to evaluate the effect of implementation of evidence-based nursing guidelines on quality of sleep in patients with acute coronary syndrome (ACS) admitted to the coronary care unit.
Patients and This before and after clinical trial was performed in Hazrat Fatima (sa) hospital in Kerman city, Iran, during 2012 - 2013. Interventions included training evidence-based nursing guidelines to nurses working in CCU and the implementation of these guidelines. Sampling was done through the convenience nonprobability method and 45 patients were placed in the before group and 45 in the after group. Patients’ quality of sleep was evaluated using the Pittsburgh sleep quality standardized questionnaire before and after the interventions and data were analyzed using SPSS software version 19, mean descriptive statistics, standard deviation statistics, inferential statistics, an independent t-test and chi-square test
The total mean score of adequate sleep was 6.71 (3.54) in the intervention group and 5.26 (2.58) in the control group. The difference was statistically significant (P = 0.03).
Implementation of evidence-based nursing guidelines improved the quality of sleep; therefore, it is recommended to administrators and managers of hospitals and health education centers to consider educating evidence-based nursing guidelines in their agenda.

The chronic disease self-management program is among the most important methods for promoting self-care.
This study was done to evaluate the effects of this program on patients’ health status after undergoing coronary artery bypass graft surgery.
Patients and This one-group pretest-posttest clinical trial was conducted in 2013 on 46 patients, who had recently undergone a coronary artery bypass graft surgery and had been referred to the cardiac rehabilitation center of Imam Ali (PBUH) Hospital, Kermanshah, Iran. The participants were recruited conveniently and were educated based on the chronic disease self-management program. The data were collected using a demographic questionnaire and the health status questionnaire and were analyzed through conducting the Chi-square test using the SPSS software (v.21.0).
The chronic disease self-management program had significant effects on the participants’ general health, daily activities and pain (P The chronic disease self-management program significantly affects various health-related parameters. It is an inexpensive non-invasive intervention, which complements conventional medical treatments and thus, can be used by rehabilitation centers.

It is difficult and stressful for mothers to care for neonates undergoing colostomy. The mothers of neonates undergoing colostomy usually lack knowledge and skills of home caring procedures; hence, they may experience great stress.
The current study aimed to evaluate the effects of an empowerment program on the stress level of the mothers of neonates undergoing colostomy.
Patients and This clinical trial was conducted in the neonatal intensive care units of the Bahrami, Mofid, and Ali-Asghar pediatric hospitals and the pediatric medical center hospital, Tehran, Iran. In total, 42 mothers were recruited and were randomly and equally allocated to the control and the experimental groups. Primarily, mothers’ stress level was assessed one day after colostomy surgery by the depression, anxiety, and stress scale-21 (DASS-21). An empowerment educational program was implemented for the mothers in the experimental group while the mothers in the control group only received the routine care of the study setting. The level of mothers’ stress was reassessed one month after the study intervention. Data analysis was performed through conducting the Wilcoxon test and was applied by SPSS version 19.
The results of the study showed that after the study intervention, stress levels in the control and the experimental groups were significantly lower than the baseline stress level (P The implementation of the empowerment program in the neonatal colostomy care alleviated mothers’ stress.

One of the leading causes of disability and mortality among patients receiving hemodialysis (HD) is HD inadequacy. Enhancing HD adequacy can improve the prognosis for these patients.
This study sought to investigate the effects of stepwise sodium and ultrafiltration profile on HD adequacy.
Patients and This crossover clinical trial was conducted on 30 patients, who were receiving HD in two HD centers, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran. Each participant received HD in four routine HD sessions and four stepwise sodium and ultrafiltration profile sessions. Hemodialysis adequacy was calculated online by a software installed on the HD machines. The data were analyzed by conducting the paired-samples t test.
The mean of dialyzer urea clearance multiplied by time, divided by volume of distribution of urea (Kt/V) ratio in the routine HD and the stepwise sodium and ultrafiltration profile groups were 1.237 and 1.395, respectively. This difference was statistically significant (P Sodium and ultrafiltration profile maintain hemodynamic stability through adjusting sodium concentration and ultrafiltration and, therefore, they improve HD adequacy, as well as patients’ tolerance to HD. Consequently, replacing routine HD techniques with this technique is recommended.

Patients’ safety is one of the basic concepts in health care systems and one of the major concerns of patient care. Medical errors are amongst the main factors that could threat patients’ safety. At intensive care units, there is always the possibility of errors during various stages such as the ordering stage.
The aim of this study was to determine the frequency of pharmacological and non-pharmacological recovered orders at intensive care units and its associated issues.
Patients and This study was a cross-sectional study based on pharmacological and non-pharmacological orders obtained from patients’ records and daily record sheets at the intensive care units of Mazandaran heart center during year 2015. All orders from patients’ records (n = 1046), which included 29214 orders, were reviewed during a three-month period. Data was collected using a researcher-made checklist and included patients’ demographic information and a medical checklist on the patients’ conditions, name of the person who had recorded the order and the person who had discovered the recovered order, type of recovered pharmacological and non pharmacological orders and related factors. To analyze the data, statistical tests such as mean and relative frequency, contingency parts and chi-square test were applied using the SPSS 19 software.
A total of 29214 pharmacological and non pharmacological orders, written in 1046 patients’ records of six coronary care units were investigated. We found that 150 (0.5%) recovered orders were documented. The results showed a significant relationship between the academic year of medical assistants and the recovered orders (K2 = 88.619, P According to this study, it is necessary to define a procedure for careful review of pharmacological and non pharmacological orders. In addition, it is recommended to use clinical pharmacologists and expert critical care nurses to allow the possibility of discovering wrong orders before putting them into practice.