نشریه پرستاری مراقبت ویژه
سال سیزدهم شماره 3 (پیاپی 47، پاییز 1399)

Patients with severe respiratory distress due to Covid-19 may require endotracheal intubation due to severe hypoxemia. To facilitate intubation and minimize the risk of staff contamination, most guidelines recommend rapid sequence intubation using hypnotics, narcotics, and muscle relaxants. The use of muscle relaxants may be associated with risks for some patients with Covid-19: Stressful environment, inexperienced nurses in newly established wards, cumbersome clothing, premature respiratory fatigue due to mask wearing, Also, the limited vision due to the formation of fog on the glasses and the surface of the face shield during laryngoscopy can make intubation difficult and time consuming. These factors, along with severe lung involvement and hypoxemia, and underlying cardiovascular diseases may exacerbate hypoxemia and expose the patient to hypoxic brain damage or cardiac arrest. Therefore, in Covid-19 patients, endotracheal intubation with full personal protective equipment and the use of hypnotics and narcotics to inhibit airway reflexes while maintaining the patientchr('39')s spontaneous respiration (deep sedation) seems to be a safer method. Otherwise, as a secondary solution, intubation is suggested by the most experienced person.

One of the environmental factors affecting development is attachment, and some factors, such as preterm infancy, can interfere with its development. Yet, one of the most important ways to increase mother-infant relationships is through massage. The aim of this study was to investigate the effect of a period of body massage on preterm infants by mothers on their attachment.

The present study was a clinical trial with experimental and control groups. For this purpose, among all infants of Amiralmomenin hospital neonatal intensive care  unit of Semnan city, 40 infants and mother’s selected purposefully and divided to experimental and control groups. According to the research protocol, the mothers of the experimental group massaged the preterm infants for 10 days, while the control group received only the usual care. To measure the level of mother-infant attachment, the Maternal Postnatal Attachment Scale was used. The questionnaire was completed in three stages: pre-test (before the start of the massage), post-test (one day after the end of the massage) and follow-up (one month after the end of the massage) by the mothers of both groups.

The results of mixed ANOVA and Bonferroni test showed that massage of preterm infants caused significant maternal attachment to infants after post-test and its persistence was maintained after one month (P<0.0001). No significant difference was observed in different stages of the test in the control group (P>0.05).

Taking the results into consideration it can be said that preterm infant massage can be an effective and at the same time low-cost way to accelerate the formation of mother-infant attachment. This issue will reduce the stress on mothers with preterm infants and help them communicate effectively and, consequently, improve optimal development of their babies in the future.

Due to the side effects of invasive techniques, the use of non-invasive techniques with continuous monitoring has been considered by health centers. In this study, invasive and non-invasive techniques for monitoring arterial blood gases were compared during patientschr('39') weaning from mechanical ventilation after cardiac surgery.

In a descriptive-cross-sectional study, 70 patients who were candidates for cardiac surgery were assessed during 1397 at Jamaran Heart Hospital and the values for oxygen saturation and carbon dioxide measured by non-invasive methods (pulse oximetry and capnography) and invasive (ABG) were compared

The results of the study showed that there is a difference of 1.7±4.54 between the copography and PaCO2 values, and a difference of 0.92±2.29 between the SPO2 and SaO2 values. There was a positive and significant correlation between ETCO2 and PaCO2 (P<0.001, r=0.43). There was also a correlation between SPO2 and SaO2 numbers (P=0.03, r=0.25). The results of the linear regression test showed that ETCO2 and SPO2 can predict PaCO2 and SaO2 using the following formula, respectively. PaCO2=20.61+0.45(ETCO2), SaO2=63.65+0.25(SPO2).

Capnography and pulse oximetry can be used as non-invasive, inexpensive, and safe methods in weaning patients from mechanical ventilation after cardiac surgery. For a more detailed examination, it is recommended that studies be performed with a larger sample size, as well as in patients with different physical conditions and severity of the disease.

Palliative care is one of the most important aspects of neonatal intensive care. Providing palliative care for infants faces many obstacles and challenges. The aim of this study was to determine the attitude to palliative care and the barriers for delivering palliative care practices among nurses in the Neonatal Intensive Care Unit (NICU).

In the present descriptive cross-sectional study, 128 nurses working in NICUs of hospitals affiliated to the Shahid Beheshti University of Medical Sciences, Tehran, Iran were selected by census method in 2018. Data were collected with "Fromelt Attitude Towards Caring   for Dying Patient" (FATCOD) and "Neonatal Palliative Care Attitude Scale" (NPCAS). 

Nurseschr('39') attitude toward palliative care was positive (102.17±4.81) and a statistically significant association was observed between shift work and nurseschr('39') attitudes (p<0.001). A strong barrier to providing palliative care was the presence of insufficient resources (10.93±2.66). Improper application of technology (5.90±1.59), organizational culture (18.69±5.25) and professional competence of nurses (18.09±4.82) were classified as intermediate barriers. The weak barrier to the implementation of palliative care was the individual and social attitude of the nurse (18.67±2.60).

Nurses have a positive attitude to providing palliative care, and it is necessary to strengthen their positive attitude by providing clinical and theoretical training. It is also important to pay more attention to eliminating other factors that can affect the implementation of palliative care. Insufficient resources are a strong obstacle to providing palliative care in neonates. So equipping the resources in terms of a suitable physical environment, adequate skilled manpower, providing counseling services and developing guidelines and policies for the nurses,   are important in order to improve the implementation of neonatal palliative care.

Understanding the problem of patients in the emergency department is essential to their satisfaction. The liaison nurse is a new nursing role. Studying its impact on the emergency department, as the heart of the hospital, is of interest. This study was conducted to determine the effect of the role of the liaison nurse on the satisfaction of patients transferred from the emergency department to other hospital wards.

The present study was a clinical trial research conducted in 2019 in Baqiyatallah Hospital, Tehran, Iran. Sixty patients were randomly divided into two groups of intervention and control (30 individuals in each group). Participants in both groups completed Wolff et al.chr('39')s Patient Satisfaction questionnaire (PSI) before and after the intervention. The intervention group received the services of a liaison nurse until the end of the transfer process in addition to the usual services. Transfer and placement of patients in the destination ward was performed and then, the PSI was completed again by the patient.

The mean patient satisfaction of the intervention group showed a significant increase (P<0.001) in comparison to the control group. The independent t-test showed that patientschr('39') overall satisfaction with the quality of nursing services increased after the intervention in the intervention group compared to the control group from a mean of 75.4 and a standard deviation of 8.2 to a mean of 99.6 and a standard deviation of 5.4.

The liaison nurse improved the patientschr('39') satisfaction to the quality of the nursing services in patients transferred from the emergency department to other wards. Therefore, designing such a role for nurses in the process of transferring patients from the emergency department to other departments is recommended.

 Stroke, as one of the most common causes of death and disability, is still increasing and it is one of the major challenges in healthcare system. Due to the difference in frequency of clinical manifestation and risk factors in different populations, this study was conducted to investigate the clinical manifestations and risk factors of stroke in stroke patients underwent thrombolytic therapy, referred to Shahid Beheshti Hospital in Qom.

 The present study was a descriptive analytic and cross-sectional study. Data was collected from the patients file. 177 diagnosed patients with ischemic stroke, underwent thrombolytic therapy, have been included in this study. The data collection was done by a questionnaire including demographic information, clinical manifestations and stroke risk factors.

 Majority of ischemic stroke patients were men (55.36%) and in the age group of 60 years and older (69.49%). The most common clinical manifestations were motor impairment (93.3%) particularly in left side of body, and subsequent speech problems (67.2%) and the most common risk factors were hypertension (46.7%) and subsequent diabetes (27.8%). There was a significant association between hypertension and hemiplegia occurrence. (P<0.05) 

 According to the results of the study, majority of stroke patients were men and the people in age of 60 years and over. People at higher risk for this disease were patients with hypertension and diabetes. Detection of high-risk groups and initiation of preventive measures against stroke can reduce the incidence rate of stroke. Community education on common clinical manifestations can also be helpful in refer faster and starting on time treatment.

Pulmonary atelectasis is one of the major problems in most chest surgeries, especially open heart surgery. This study was performed to investigate the effect of standard nursing care package (appropriate bed height, breathing exercises and postural drainage) on the severity of atelectasis in patients after open heart surgery.

In the present randomized clinical trial, 60 eligible patients who had open heart surgery were selected by available sampling method and then randomly divided into four blocks of intervention (30 patients) and control (30 patients). They got. In the control group, routine care was performed in the ward and for the intervention group. Data collection tools, data sheet and chest radiography were used to diagnose atelectasis.

The results showed that the intervention and control groups did not differ significantly in terms of demographic characteristics. The results also showed that although the incidence of atelectasis was lower in the intervention group than the control group, but this difference was not statistically significant (P> 0.05).

Due to the lack of effect of care package on reducing the incidence of atelectasis, it is suggested that due to the temporal and spatial limitations of this study, wider studies should be performed in other centers and more patients.