نشریه پرستاری مراقبت ویژه
سال چهاردهم شماره 4 (پیاپی 52، زمستان 1400)

Hemodialysis is the most common treatment in the final stage of renal failure that despite the efforts of the health care system, this disease and its treatment method affects the lifestyle and health status of patients. One of the effective methods in improving the adequacy of hemodialysis is to increase the rate of blood flow and the rate of the hemodialysis machine. The aim of this study was to determine the effect of increasing the speed of blood flow on physiological parameters and complications of dialysis in hemodialysis patients.

The present study was a cross-sectional interventional study (pre and post intervention). For this purpose, 37 patients who had referred to the hemodialysis center were included in the study by census. After recording the demographic characteristics of the patients, the intervention was performed on the participants. In two sessions, the blood flow rate was set to 250 ml/min and in two sessions the blood flow rate was set to 350 ml/min. Then blood pressure, heart rate and arterial blood oxygen indices were measured before, mid-hour of hemodialysis and at the end of hemodialysis with 250 ml/min and 350 ml/min remote pump.

Mean heart rate and arterial blood oxygen level, systolic and diastolic blood pressure in the two-dialysis groups with blood pump speed of 250 ml/min and 350 ml/min in hemodialysis did not show a significant difference (p>0.05). In addition, no statistically significant difference was observed between the two pump cycles in regards to the frequency of complications such as hypotension and muscle cramps (p>0.05), no statistically significant difference was found between the two pump cycles (p>0.05).

A round of 350 ml/min hemodialysis machines can be used as an effective and appropriate non-pharmacological agent without any specific physiological complications in dialysis patients.

Hypertension is considered to be a silent death and due to the effect of psychological interventions on it, research in this field is necessary. The aim of this study was to investigate the effectiveness of mindfulness-based group therapy and acceptance and commitment on perceived stress, emotional cognitive regulation and self-care behaviors in patients with hypertension.

The research design was quasi-experimental and pre-test, post-test and follow-up with a control group. The statistical population included patients with hypertension who had referred to health centers in Kish in 1399. Among them, 48 were purposefully selected and replaced in two experimental groups and one control group. The research groups received eight sessions each, with mindfulness training and acceptance and commitment-based therapy, while the control group did not receive any training. The data collection tools included the perceived stress questionnaires, emotional regulation and self-care behaviors of hypertensive patients.

The results showed that group therapy based on mindfulness and acceptance and commitment therapy have a significant effect on perceived stress and emotional regulation (p<0.001). Also, treatment based on acceptance and commitment among the components of self-care had a significant effect on the components of diet and medication (p<0.01).

Based on the findings of this study, mindfulness therapies and acceptance and commitment therapy can be used to improve perceived stress and emotional cognitive regulation in patients with hypertension.

Hemodialysis sessions affect the quality of life of hemodialysis patients. One of the cares during dialysis is enough exercise and mobility to improve their quality of life. The aim of this study was to determine the effect of self-centered open physical activity training on the quality of life of hemodialysis patients.

In this single-blind clinical trial study with a control group, 90 patients who had referred to dialysis centers of Beheshti and Besat hospitals in Hamadan in 2018 were selected by convenience sampling method and were randomly assigned with block of six blocks to two experimental (n=45) and control (n=45) groups. Data collection tools in this study were demographic information checklist and standard quality of life questionnaire for kidney patients that were completed before the intervention and at the end of the second, fourth, sixth, eighth and twelfth weeks after the intervention by the research samples. In the intervention group, during dialysis sessions for twelve weeks, patients were taught how to perform physical activities with pilates stretches in different resistances, using the self-centered open training method.

The results showed that there was no significant difference in the demographic characteristics of the research samples between the intervention and control groups (p˃0.05). Before the intervention, there was no significant differences between the two groups in terms of mean scores of different dimensions of quality of life (p>0.05); but after the intervention, this difference was statistically significant in other dimensions except the burden of kidney disease (p<0.05).

Self-centered open training of physical activities to hemodialysis patients can be effective in increasing their quality of life. Therefore, recommending exercise and including it in dialysis care program can be effective in promoting patients' health.

Health care methods have made undeniable progress in maintaining patients' health, but assessing the expected recovery and health of these methods is still done by basic criteria such as mental estimates and approximate physicians. These methods have a high probability of error in predicting patient mortality and survival. The aim of this study was to investigate the comparison between REMS and APACHEIII criteria in non-surgical patients referred to the emergency department of Imam Khomeini Hospital in Urmia in the second half of 2019.

In this cross-sectional descriptive study, 662 patients were enrolled in the study by census method. Data were collected by checklist. Finally, the mortality rate was predicted using REMS and APACHE III systems.

The results of the study showed that out of 662 patients (55.9%), 370 were male and (44.1%) were 292 females, the mean age of patients was 62.56±14.61 years. The mean scores of APACHE III and REMS in all patients were 53.32±17.96 and 9.79±4.05, respectively. The mean REMS in living patients was 7.21±3.8 And in deceased patients was 13.29±4.41. Also, a significant direct relationship was observed between APACHE III score (r=0.437) and REMS (r=0.241) with the length of hospital stay. The area below the ROC curve chart for APACHE III was higher than REMS, indicating that APACHE III was better at predicting patients' clinical outcome.

Overall, the APACHE III criterion performed better than the REMS in predicting the clinical outcome of non-surgical patients referred to the emergency department, and the mean scores of REMS and APACHE III were higher in deceased patients than in surviving patients.

Coronary artery disease is one of the most common forms of cardiovascular disease. Angioplasty is a common technique for its treatment. Adherence is an important factor in preventing the progression of coronary heart disease in patients undergoing angioplasty. Therefore, the present study was conducted in order to determine the medication adherence in patients undergoing repeat angioplasty in Shaheed Rajaei Cardiovascular Medical and Research Center in 2021.

This cross-sectional study, was performed on 92 patients referring to Shaheed Rajaei cardiovascular medical and research center undergoing coronary artery restenosis following repeat angioplasty. Patients were selected with convenience sampling. The instruments used in this study included the demographic information scale and the Medication Adherence Rating Scale) MARS.(

The mean of patients’ age was (60.60±6.53) and the majority of the patients were males (55%), and mostly under diploma (34%). The mean score of professional self-concept was 3.04±1.21. The intentional medication noncompliance with the mean of (2.82±0.96) was higher than unintentional medication noncompliance with the mean of (0.23±0.47). There was inconsistency between adherence to Medication and demographic information, which indicates the fact that medication non-adherence, was not seen in the whole study population.

Considering that almost the majority of patients did not have medication adherence after angioplasty and were referred for repeat angioplasty, therefore, nurses should help with the prevention of repeat angioplasty through the use of appropriate measures influencing adherence to the therapeutic plan at discharge from the hospital.

Nursing care activities in the times of infectious epidemics can cause double stress for nurses. The aim of this study was to evaluate the level of job stress of nurses caring for COVID-19 patients based on evidence from a large hospital.

This was a cross-sectional study in Mashhad city, Iran. The sample consisted of 323 nurses caring for 19 patients in Imam Reza (AS) Hospital in 2020 who were selected through random quota sampling. Data collection tools were demographic information checklist and NSS Nursing Stress Questionnaire.

The overall level of stress was moderate (62.44 out of 102). Overall stress in specialized wards and in nurses with a history of activity in infectious wards were 8% and 1% less than others, respectively. Nurses' job stress in terms of interpersonal relationships and the performance of supervisors in normal wards was higher than special wards (P value=0.020).

Based on the findings of this study, it is possible to reduce the level of stress by training nurses and simulating the ICU environment to prepare for emergencies and epidemics, as well as encouraging them to rotate work between the ICU and inpatient wards during service.

Intrahospital Transport (IHT) of critically ill patients is always associated with the incidence of Adverse Events (AEs). Identifying and managing these events ensures the safety of patients. The aim of this study was to determine the incidence of AEs and related factors in IHT of critically ill patients.

In this prospective observational study, 171 cases of Intensive Care Unit (ICU) patients transferred in the first half of 2019 were investigated. After obtaining the approval of the Research Ethics Committee, the study data were collected and recorded by using a researcher-made checklist during the transfer process.

In 79.54% of IHTs, at least one AEs occurred. The highest number of AEs (37.39%) occurred during transfer phase. Decreased Spo2 (43.39%) and decreased level of consciousness (42.15%) were the most common ADs, respectively. Multiple logistic regression analysis identified endotracheal intubation as independent predictor of AEs in the transportation process.

According to the findings, the incidence of AEs during the IHT process of ICU patients is high. Critically ill patients with endotracheal intubation were at higher risk. Adoption of strategies such as efficient and adequate transfer team composition, continuous monitoring of patient status, use of standard checklists and sound equipment are crucial.

This study was carried in order to investigate the degree of agreement and correlation between arterial and venous blood gas parameters and the possibility of replacing intravenous blood instead of arterial blood gas test according to scientific evidence.

This narrative review was done by searching the databases of SID, PubMed, Web of Science, Scopus and Google Scholar search engine, using the keywords arterial blood gases, venous blood gases from 2005 to 2020. A total of 24 related articles were found and after screening, 16 articles were reviewed and analyzed.

Review of studies examining the correlation of the agreement between ABG and VBG parameters often found a good relationship, especially between the PH and HCO3 values of arterial and venous blood. The use of intravenous PCO2 instead of arterial blood, although some studies have introduced intravenous PCO2 as an acidemy screening tool, is still debated and needs further study.

Venous blood gas test can be a safe, easy and low-cost option to assess patients' blood gas status. However, considering the clinical condition of patients when using VBG is recommended and ABG analysis will commend only if necessary.