نشریه پرستاری مراقبت ویژه
سال شانزدهم شماره 3 (پیاپی 59، پاییز 1402)

Delirium is an unpleasant experience for patients and their family, which brings complications for them. Early diagnosis and reduction of risk factors affecting delirium requires the knowledge and awareness of doctors and nurses of special care departments about the nature of delirium symptoms, disease symptoms and factors affecting the occurrence of this syndrome. The present study was conducted with the aim of determining the factors related to delirium in patients and family caregivers of patients admitted to the Intensive Care Unit (ICU).

In this cross-sectional study carried out in 2023, 256 pairs of patients admitted to the ICU in hospitals affiliated to Tehran University of Medical Sciences and their family caregivers were selected using the proportional stratified sampling. To collect information, three questionnaires including demographic information, CAM-ICU questionnaire and sour seven questionnaire were used.

The patients participating in the research had an average age of 41.75 ± 17.07 and most of them were male (55%) with an average number of hospitalization days of 11.84 ± 8.82. Delirium was reported positively in 210 cases of patients (81.7%). Family caregivers had an average age of 42.25 ± 14 and were mostly women (66.9%). In addition, 171 (66.5%) of family caregivers had reported symptoms of delirium. The results of the statistical analysis showed that there is a statistically significant relationship between delirium in patients and delirium in family caregivers in the samples of the participants in this study (P<0.5).

Considering the high rate of delirium reported in patients and caregivers of patients hospitalized in the ICU, identification and screening of delirium is very important. By knowing the individual characteristics and factors related to the occurrence of delirium identified in this study and to the extent possible to correct some cases or support the caregivers, the ground can be prepared to improve the quality of care in the care system.

Cardiac arrest and heart attack are the most common cardiovascular diseases in the world. Most of the time, during a cardiac arrest, there is a person as an observer who can prevent brain death and save the patient's life in the golden time (first 4 to 6 minutes of cardiopulmonary arrest) by performing resuscitation. The aim of this study was to compare two methods of basic cardiopulmonary resuscitation training in person and virtual on the level of learning resuscitation skills (awareness and performance) in military families.

In this clinical trial study, 100 people from families living in selected organizational areas were randomly assigned to two groups of face-to-face training (50 people) and virtual training (50 people). In the face-to-face training group, during a 2-hour session, cardiopulmonary resuscitation and how to deal with cardiac arrest victims were taught theoretically and practically (mannequins). In the virtual educational group, educational materials were presented by using virtual channels (once-up Weita platform) and sending animation videos, photos, short texts, and PDF files of educational booklets during two weeks. In order to collect data, a demographic form, an awareness questionnaire including 14 four-choice questions, and a performance assessment checklist including 13 items were used to assess the skill in cardiopulmonary resuscitation. At the end, the collected data were compared between the two groups.

Data related to age (P = 0.468), sex (P = 0.812), education (P = 0.307), occupation (P = 0.055) had no significant difference in the two groups. The U-Man-Whitney test showed that there was no statistically significant difference before the intervention between the two groups of face-to-face and virtual education in terms of knowledge and skill levels (P>0.05). Wilcoxon's statistical test showed that the difference in the mean score of knowledge and skill level before and after the intervention in both face-to-face and virtual education groups was statistically significant (P<0.05). Furthermore, the U-Man Whitney test showed that there is a statistically significant difference after the intervention between the two groups of face-to-face and virtual training in terms of knowledge and skill level (P<0.05).

In this research, in both face-to-face and virtual training groups, the amount of knowledge and skill increased significantly compared to before and after the training. However, by comparing the two groups, it was observed that the amount of knowledge in the participants of the virtual training group was higher and the amount of skill in the participants of the face-to-face training group were more. Despite the belief of the effectiveness of face-to-face training, the findings of this research showed that virtual training can be as effective as face-to-face training.

Clinical evaluation is one of the main components in the discussion of clinical education in the field of nursing. Based on Miller's Pyramid in Education, objective structured clinical examination becomes one of the applied assessment methods to evaluate clinical skills. One of the clinical skills of nurses, especially in the Intensive Care Unit (ICU), is mechanical ventilation. This study was conducted with the aim of designing an objective structured clinical examination to evaluate the competence of nurses in mechanical ventilation.

This descriptive study was conducted in 1401 in Tehran, Iran. According to the educational content of basic mechanical ventilation principles and the purpose of the study, six stations were determined and a specialized checklist was designed accordingly for each station. Checking the validity of the content of the designed checklists was done using the opinions of experts in both qualitative and quantitative ways.

Finally, the number of six stations with 31 items with titles; Tubing connection and initial preparation of the ventilator, initial and basic settings of the ventilator, check and intervention in the oxygenation status, check and intervention in the ventilation status, management of clinical challenges and management of alarms were finalized. Scoring ranged between 1 and 5, and the sum of the scores of the stations would indicate the nurse's clinical competence in mechanical ventilation.

According to the results of the present study, the use of an objective structured clinical examination designed to evaluate the clinical competence of nurses in basic mechanical ventilation is suggested.

Professional collaboration is regarded as a major contributory factor in the development of high-quality and safe care. However, only a few studies have explored this factor. The present study has aimed to investigate the relationship between professional collaboration and the quality of nursing care of nurses in Intensive Units (ICUs) of the hospitals affiliated to Shiraz University of Medical Sciences.

This cross-sectional study was conducted from May 2021 to March 2022 on 330 ICU nurses from large teaching hospitals affiliated to Shiraz University of Medical Sciences. The subjects were selected by stratified random sampling. Data were collected using the Professional Collaboration scale related to Professional Practice Environment Nursing Instrument and the Nursing Care Quality Scale. The P value was set <0.05.

The means of the nurses’ ages and work experience were 28.5 ± 4.54 and 7.99 ± 6.51 years respectively. The nurses’ mean score for the professional collaboration subscale was 20.47 ± 5.04; their quality of nursing care mean score was 135.94 ± 18.20. The results showed a significant direct correlation between the variables of professional collaboration and the quality of nursing care (r = 0.62, P<0.001). The results of multivariate regression model showed that compared to the other dimensions of nursing care quality, the dimension of ethics-oriented activities was more explained by professional collaboration (ß = 0.39, P<0.001). In addition, the professional collaboration can predict 0.52% of the variance in the quality of nursing care.

According to the findings of this study it can be stated that it is essential that educational programs with an emphasis on professional ethics values be developed to enhance nurses’ competence in professional collaboration and quality of care.

Technological advancements have greatly aided patients in various ways to address and control life-threatening conditions. One such biomedical technology is ventilators. Over time, the number of patients requiring ventilators for their respiratory support has increased. The objective of this study was to explore the lived experiences of a patient with spinal cord injury dependent on a ventilator.

This qualitative case study focuses on the lived experiences of a 31-year-old male who has relied on ventilator-assisted breathing for 23 years and has been hospitalized during this time. Data was collected through semi-structured interactive interviews. Data analysis was conducted using a phenomenological approach inspired by Van Manen.

From the analysis of the data, 170 meaningful units were identified, leading to three main themes: "fears and concerns", "satisfaction with agency", "life goes on", and eight sub-themes: "initial hard days, struggle with death, respiratory suffering, joy of training and Learning, participating in care, a family in the hospital, I'm comfortable on a ventilator, and living within God's eyes”.

Knowing about the experiences of ventilator-dependent patients leads to a better understanding of nurses and other caregivers towards these patients. Reducing stressful factors (constant monitoring, being on time at the bedside, helping the family to be with the patient and getting familiar with the environment), creating a situation for the client to have a sense of control, participation and hope in life (providing situations for decision making and the patient's participation in the care, the formation of learning opportunities, responding to spiritual needs and its cultivation) can provide them with sweet and satisfying moments.

Following the hospitalization of patients in Intensive Care Units (ICUs), their family members are exposed to a series of physical, psychological, social, and spiritual reactions named Post Intensive Care Syndrome-Family (PICS-F) which can endanger their public health and requires attention to related factors. Therefore, this study aimed to investigate the correlation of PICS-F with quality of communication between nurses and families of patients hospitalized in ICUs of Zanjan University of Medical Sciences.

The current study was a cross-sectional study that was conducted in 2022 in hospitals affiliated to Zanjan University of Medical Sciences. The study population consisted of 193 family members of patients hospitalized in the ICUs, who were selected through available and purposeful sampling method. The research tools included PICS-F questionnaire and Quality of Communication (QOC) questionnaire between nurses and families.

In this study, the average score of PICS-F was 74.51 ± 6.16 and 73.90 ± 18.5 for quality of communication between nurses and patients' families. The analytical results showed a significant negative correlation (P<0.05) between these two variables. This means by decreasing the quality of communication, the PICS-F will increase.

The results of this study stated that critical care nurses should pay more attention to effective communication with the patients' families. Also, hospital managers and administrators should develop some strategies in order to improve the quality of communication between nurses and patients’ families. Furthermore, necessary measures should be taken to implement family-centered care in the ICUs to prevent and reduce the incidence of post-intensive care syndrome.

Nursing care is an essential part of health care services and should be fully provided. Missed nursing care is a major threat to patient safety and health care quality. The purpose of this study was to determine the amount and reasons for missed nursing care in infection control and prevention from the point of view of care providers working in the medical, educational, and therapeutic center of Besat Sanandaj during 2023.

This cross-sectional study was conducteed in Besat Hospital, one of the teaching hospitals of Kurdistan University of Medical Sciences. The research samples in this cross-sectional study included 389 nurses and midwives working in Besat Hospital who were included in the study by census. To collect data, three tools were used: a demographic information registration form, a questionnaire on the missed nursing care in infection prevention and control, and a questionnaire on factors related to missed care.

The findings of the present study showed that the average score of missed nursing care in infection prevention and control was 75.83 ± 23.28 and below the average. The most important missed nursing care from the point of view of the nurses and midwives of Besat Hospital was the use of personal protective equipment by the service personnel of the department (4.88 %), the report of the patient's infection status when transferred to another department or paraclinical unit such as radiology (3.86 %), and teaching patients about bathing before surgery (3.86 %). The most important factor of forgotten nursing care was unexpected increase in workload and number of patients in the ward (79.69 %) along with insufficient number of nursing and midwifery personnel in the ward (32.75 percent). A statistically significant relationship was observed between forgotten nursing care in infection prevention and control with the related factors (P = 0.0001), (R = - 0.1940).

The missed nursing care in the prevention and control of infection from the point of view of nurses and midwives of Besat Hospital was average. The most important factor was the unexpected increase in the workload the number of patients and the lack of personnel. The people participating in the research emphasized the role of systemic, organizational, and management factors in preventing effective infection control. Therefore, it seems necessary to reduce the factors that cause missed care with proper planning and management by reducing nurses' workload and providing budget and manpower.

The Intensive Care Unit (ICU) is a specialized hospital unit designed to provide care for critically ill patients. Nurses who work in these departments play an important role in ensuring patient safety and providing safe and quality nursing care. However, various factors can affect nurses' ability to provide safe nursing care in these settings. This study was conducted with the aim of investigating the factors affecting safe nursing care in the ICU department.

The present study was a qualitative study of conventional content analysis. The participants included nurses, doctors, and specialists in the field of patient safety, patients and accompanying patients. A total of 20 individuals were included in the study using purposive sampling method. Data collection was done using individual, in-depth and semi-structured interviews. Then, data analysis was done using the method proposed by Graneheim and Landman (2004) and the views of nurses and people related to patient safety in ICU were identified.

Two themes including holistic care and safety-oriented organization and four categories including systematic care, comprehensive care of all systems, human resource management and safe environment were extracted as effective factors in providing safe nursing care in ICU departments.

The results of this study reveal the importance of promoting safe nursing care in ICU departments through a holistic care approach as well as a safety-oriented organization. These findings support previous research that emphasizes the importance of systems thinking and safe nursing care in improving patient safety and overall quality of care. In this way, by implementing targeted interventions and strategies based on these factors, healthcare organizations can create a safer environment not only for patients but also for the staff of the ICU.