نشریه پرستاری مراقبت ویژه
سال هشتم شماره 3 (پیاپی 28، پاییز 1394)

There are few studies in the area of managing delirium by using complementary therapies. The aim of this study was “to investigate the effects of face and head massage on delirium among elderly women hospitalized in coronary care units”. This was a clinical trial study. Eighty eight elderly women with delirium were randomly allocated to either the control or the experimental groups. Women in the experimental group received fifteen-minute face and head massage therapy. Study data were collected and analyzed by using the NEECHAM confusion scale and the SPSS18، respectively. Before the study intervention، the means of total delirium score in the experimental and the control groups were 8. 8 and 9. 5، respectively. There was no significant difference between the study groups regarding the pretest total delirium score. However، after the study intervention، the mean total delirium score in the experimental group was significantly higher than that of the control group (17. 6 vs. 16. 7; p=0. 03). Face and head massage therapy can reduce delirium severity; therefore، using it in adjacent to pharmacological interventions is recommended.

Short term foot massage helps regulate the vital signs of patients who are hospitalized for long periods of time in intensive care units. The purpose of this study was “to examine the immediate impacts of short-term foot massage on mean arterial pressure among neurosurgical patients hospitalized in intensive care units”. This quasi-experimental study was conducted in 2013 on 78 patients who had been conveniently recruited from the intensive care units of Imam Reza (PBUH) Hospital, Kermanshah, Iran. Patients were equally and randomly assigned to the experimental and the control groups. Study data were collected by using a demographic questionnaire and a blood pressure data sheet which were completed through observation, interviewing, and physiologic measurement. Mean arterial blood pressure was measured both five and one minutes before the intervention. Then, the feet of each patient in the experimental group were massaged for five minutes and mean arterial pressure was re-measured one and five minutes afterward. The SPSS16 was used for calculating the measures of descriptive statistics and conducting the paired- and the independent-samples t tests. In the experimental group, mean arterial blood pressure decreased significantly both one minute (93.23±14.16; p=0.005) and five minutes (89.76±13.66; p<0.005) after the study intervention. However, within-group comparison revealed that means arterial blood pressure did not change significantly in the control group after the intervention. Foot massage is effective in decreasing mean arterial pressure and giving patients a sense of calmness.

Hospitalization in critical care units is associated with anxiety for patients and family members due to encountering unfamiliar and strange equipments and procedures. Such anxiety and unfamiliarity can bring patients dissatisfaction. This study was conducted “to examine the effects of the Family-Centered Orientation Program on satisfaction with healthcare services among patients with coronary artery disease”. A convenience sample of 80 patients with coronary artery disease was recruited to this clinical trial study from the coronary care unit of a teaching hospital affiliated to Zanjan University of Medical Sciences, Zanjan, Iran. Patients were randomly allocated to the control and the experimental groups. The Family-Centered Orientation Program was implemented for patients in the experimental group. Patient satisfaction with care services was evaluated at the time of hospital discharge by using the Patient Satisfaction Scale. Study data were analyzed by employing the SPSS17 software as well as the Kolmogorov-Smirnov, the independent-samples t, and the Fisher’s exact tests. After the study, the level of satisfaction with care services in the experimental group was significantly higher than the control group (p<0.0001). Family-Centered Orientation Program is effective in enhancing patient satisfaction. Using this program for improving care quality and enhancing patient satisfaction is recommended.

The demand for hospitalization in intensive care units is increasing. The purpose of this study was “to investigate the causes and the consequences of hospitalization in the intensive care units”. All patients hospitalized from July 20, 2010 to July 20, 2011 in Shohaday-e Ashayer Hospital, Khorramabad, Iran, were recruited to this observational descriptive-analytic study by using the census technique. The data collection instruments were the Sequential Organ Failure Assessment (SOFA) scoring and a demographic questionnaire whose validity and reliability had been confirmed. Study data were analyzed by using the SPSS v. 19.0. The most common cause of hospitalization in intensive care units was traffic accidents (42.2%). About 62.2% of the study participants developed hospital-acquired complications, chiefly pneumonia (24%). Mortality rate among the study participants was 29.13%. There was a significant correlation between the length of hospital stay and the rate of hospital-acquired complications. The rate of hospitalization in intensive care units can be reduced through adopting strategies for preventing traffic accidents and brain strokes. Moreover, the rates of mortality and hospital-acquired complications can be decreased by shortening patients’ stay in intensive care units.

Spiritual well-being has been recently considered as one of the main aspects of human life. Nurses’ competence in providing spiritual care is directly related to their spiritual well-being and their awareness of spirituality. This study sought “to assess coronary care nurses’ spiritual well-being and their perspectives on barriers to providing spiritual care”. This descriptive-correlational study was conducted in 2013. The study setting was all hospitals with coronary care units affiliated to Isfahan University of Medical Sciences, Isfahan, Iran. All 88 nurses practicing in the study setting were recruited through the census method. Participants were invited to complete the Paloutzian and Ellison’s standardized Spiritual Well-being Scale and the researcher-made valid and reliable Barriers to Spiritual Care Delivery Questionnaire. The study data were analyzed by conducting the Chi-square, the Pearson and the Spearman correlation, and the independent-samples t tests as well as regression analysis in SPSS18. Most of the study participants were female (87.5%) and worked in rotational shifts (86.4%). The mean of participants’ age was 38.76±5.92 years. Participants’ mean score of spiritual well-being was 90.06±14.88. This finding denotes that the level of nurses’ spiritual well-being was higher than moderate. Moreover, nurses’ spiritual well-being was negatively correlated with barriers to spiritual care delivery (r=0.35 and p=0.001). The most important barriers to spiritual care delivery are nurses’ greater involvement in alleviating patients’ physical problems, their own preoccupations and personal problems, and lack of educational programs and workshops in the area of spiritual care. Healthcare authorities need to adopt strategies for improving nurses’ spiritual well-being and lowering barriers to spiritual care delivery.

Jaundice is among the most prevalent problems among neonates which can have toxic effects on the brain and cause serious complications. The commonest treatment for neonatal jaundice is phototherapy. Providing phototherapy by using clinical standards can enhance its effectiveness and safety, reduce its duration, shorten hospital stay, and minimize phototherapy-related complications. The aim of this study was ‘to evaluate the accordance of phototherapy-related nursing care services with the current standards”. In this descriptive study, 120 phototherapy-related care delivery episodes were selected in 2013through time and event sampling and were observed and assessed by using a checklist. The checklist had been developed based on a literature review and the current standards. The validity of the checklist was established through content validity assessment and its reliability was confirmed by an inter-rater interclass correlation coefficient of 0.78. Study data were gathered through observing and documenting phototherapy-related care services provided in the neonatal care wards and neonatal intensive care units of four hospitals affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran. The data were reported by using the measures of descriptive statistics which had been calculated by using the SPSS21. The accordance of phototherapy-related nursing care services with the current standards in the study setting was moderate (58.7%). Phototherapy-related care services are way below the standards. This can be related to factors such as care providers’ inattentiveness, educational shortcomings, inadequate clinical supervision, limited equipment and facilities, and nurses’ lack of knowledge about the importance and the outcomes of accurate phototherapy-related care services.

Most patients hospitalized in intensive care units suffer from restlessness, confusion, and delirium. Physical restraint seems to be the only acceptable measure for ensuring patients’ own and others’ safety in certain cases in which other interventions are not applicable or useful. The aim of this study was “to evaluate the application of physical restraint standards in intensive care units”. This was a cross-sectional descriptive study. A convenient sample of 120 physically restrained patients was recruited from the intensive care units of selected hospitals of Tehran University of Medical Sciences, Tehran, Iran. The data collection tool was an observational checklist for physical restraint standards. The SPSS16 was used for calculating the measures of descriptive statistics and conducting statistical tests. Most of the participating patients were male (65.8%), aged 50–60 years (62.5%), and had a Glasgow Coma Scale score of less than 8. The Fisher’s exact test revealed a significant difference among the studied intensive care units and also among the three phases of using restraint (i.e. before, during, and after restraint use) regarding the rate of applying restraint standards (p≤0.001). Moreover, restraint standards were minimally applied in the study setting. Educating nurses—as the first decision makers for restraint use—and familiarizing them with restraint-related clinical guidelines are crucial.

Nursing cares regarding Neonate of diabetic mother, is a key factor in increasing of chance of life of this neonates. In this field nurses have many challenges. The aim of this study was “to investigate nursing care conformity rate with existing standards, regarding neonate of diabetic mother in maternity, operation room, neonatal and neonatal intensive care”. In this descriptive study (Auditing), 400 nursing care regarding to neonate of diabetic mother were observed in 2014. Research society and research samples included nursing cares regards neonate of diabetic mother that were in operation room, maternity, neonatal and neonatal intensive care units at Babol university of medical sciences selected hospitals, research samples were collected by 1 observer in day, night and evening shifts. Data collected using 3 checklists included standard cares regarding to neonate of diabetic mother, which was developed according to reviewing literatures and existing standards. Content validity and inter rater coefficient reliability (ICC=0.95 in neonatal, NICU and operation room wards, in maternity ICC=0.98) were calculated for checklists. Data collection method was observation and recording items of checklists. Sampling was in two Event sampling and time sampling which last 4 months. Data were considered by descriptive methods. conformity rate of nursing cares regarding to neonate of diabetic mother in Neonatal and NICU wards of selected hospitals 85.1%, maternity 79% and operation room 62.6% were evaluated. Nursing cares regarding neonate of diabetic mother in operation room and maternity are far from standards, which can attribute to lack of familiarity of health providers with standards nursing cares and lack of training.