نشریه پرستاری مراقبت ویژه
سال دوازدهم شماره 1 (پیاپی 41، بهار 1398)

The incidence and prevalence of delirium in the intensive care unit (ICU) are extremely high. Generally, the incidence and prevalence of delirium in the hospitalized patients in ICU are 29-31% (1, 2) and 11-25% (3, 4), respectively. Each additional day with delirium increases a patient’s risk of dying by 10%. The incidence of delirium among mechanically ventilated patients compared to non-intubated patients is reported 45 to 87% more (5-8).  
Due to the high prevalence of delirium in hospitalized patients in the ICU, the many effects of delirium on the short and long term outcomes of patients, and the imposition of high costs on the health system; several studies have assessed the impacts of delirium to outcomes of patients and healthcare systems (8,9). Recently, a study looking at costs over 1 year following an episode of delirium, estimated that delirium is responsible for between $60,000 and $64,000 of additional health-care costs per patient with delirium per year; at national level, total direct 1-year health-care costs attributable to delirium might range from $38 billion to up to $152 billion nationally (9). The cost associated with delirium in mechanically ventilated patients in the United States of America is around 4–16 billion dollars per year (10) which is impacts of the delirium on the health system.
The short-term implications of delirium for hospitalized patients in ICU include prolonged hospital stay, functional decline during hospitalization, increased risk of developing a hospital-acquired complication, and increased admission to long-term care (11, 12).
Chronic cognitive impairment and different physical and psychological functional disability are among the long-term impacts for hospitalized patients in ICU (13).
In overall, it can be concluded that there are differences between the complications of Delirium incidence, both short and long term, in admitted patients to the ICU by sex, socioeconomic status, race, ethnicity, and even the degree to which one practices an organized religion (religiosity) (14).  
According to the definition, religiosity and spirituality are broadly defined as feelings, thoughts, experiences and behaviors that arise from searching for the “sacred,” with former implying group or social practices and doctrines, and the latter referring to personal experiences and beliefs (15, 16).   
It’s been reported that approximately 90% of Iranians (USA 84%) report religious affiliation, and 96% of Iranians (USA 82%) report religion as at least somewhat or very important in their lives (17, 18).
Several systematic reviews of the literature support a relationship between religiosity promoting improved health behaviors (19, 20) and lower all-cause mortality (21, 22).
Emerging evidence suggests that religiosity and spirituality are correlated with improved mental and physical health outcomes, including decreased rates of depression (23), anxiety, post-traumatic stress disorder, suicide, and coronary heart disease (24).
Despite the recognition of the impacts of the delirium occurrence and its high cost on the health system from one side, and the relationship between religiosity and the delirium event, which significantly improves the consequences of it, from other side (19-22), to the best knowledge of the researchers, Still, the study does not investigate the effect of religiosity and spirituality on the severity of delirium to determine whether different levels of religiosity and spirituality cause different levels of delirium in admitted patients to the ICU or the effects of medications, the environment of the ICU and so on …. without affecting the different levels of religiosity, there are different degrees of delirium? which brings up a chicken-or-the-egg conundrum.

Nausea, vomiting, diarrhea and constipation are some of the common problems of hospitalized patients. These problems are exacerbated by the hospitalization of patients in the Intensive Care Unit (ICU). The purpose of the present study was to evaluate the prevalence of nausea, vomiting, diarrhea, and constipation of hospitalized patients in the ICU.

This research was a cross-sectional study. In the study, 104 hospitalized patients in the ICU were selected through convenience sampling in a period of six months, from the 1st September 2018 to the 1st of March  of the same year, based on the inclusion criteria. Data were collected using demographic and nutritional status assessment questionnaires.  Data were gathered using demographic and nutritional status assessment questionnaires retrieved from a specific form in this regard from the Ministry of Health.

Hospitalized patients in the ICU were evaluated for nausea, vomiting, diarrhea, and constipation. Among them, 50% had vomiting, 44.3% had nausea, 35.7% had diarrhea, and 12.7% had constipation.

Given the significant adverse nutritional outcomes of the hospitalized patients to the ICU, considering a standardized and condition-based plan may reduce the negative nutritional outcomes of these patients.

Quality care providing is one of the main goals of health care services and a nurse is a team axis and plays a key role in this issue. Therefore, the aim of this study was to evaluate the quality of nursing care from nurses' point of view and its relationship with demographic and professional variables.

This research was a descriptive-analytic study that was performed by a demographic and standard Quality Patient Care Scale (QUALPAC) questionnaire which has 72 questions in terms of psychosocial, physical and communication dimensions based on a Likert scale. The sample consisted of 200 nurses who worked in the intensive care unit of Isfahan- Iran.

According to the participant's viewpoints, the average quality of nursing care in patients was favorable in physical and communication dimensions (2.63 ± 0.29). It was also to some extent desirable in the psychosocial aspect (2.45 ± 0.28). Also, there was a significant relationship between age, experience, type of employment, amount of overtime working and the quality of nursing care (p <0.05).

Considering the significant relationship between professional characteristics and the quality of holistic nursing care, it is suggested that health managers adjust the amount of overtime hours and also take into account the experience of expert nurses in order to take an effective step in formulating necessary policies in improving the quality of nursing care.

Uremic pruritus due to chronic kidney disease is one of the most important and common symptoms in these patients as well as more severe in patients with end-stage renal disease. Evidence suggests that mental disorders, especially anxiety and depression, are very common in patients with chronic renal failure and undergoing hemodialysis; The aim of this study was to determine the level of anxiety and depression in hemodialysis patients with uremic pruritus in selected hospitals of Tehran in 2019.
 

This is a cross-sectional analytical correlational study. The study population consisted of 300 hemodialysis patients with uremic pruritus in selected hospitals of Tehran in 2019 randomly selected. The instruments used in this study were demographic information questionnaire, Yosipovitch Pruritus questionnaire, Hospital Anxiety and Depression questionnaire (HADS).
  

The sample in this study was 300 persons. The mean anxiety score was 2.14 ± 10.14 and the mean depression score was 2.41±9.62 indicating high levels of anxiety and depression in these patients. Among the demographic variables, there was a statistically significant relationship between the underlying diseases with the level of anxiety and depression. According to the p-value, there is a significant positive relationship between mean severity of uremic pruritus   and anxiety and depression.

The results of this study showed that the level of anxiety and depression in hemodialysis patients participating in the study was high which could risk their health. The results also show that the higher the severity of the pruritus, the greater the degree of anxiety and depression. Therefore, it is possible to reduce the severity of depression and anxiety in these patients by providing appropriate strategies for the treatment of pruritus.

The way that the nurses working in Emergency Departments (ED) encounter the patients under mechanical ventilator is different and their knowledge is limited in this field. Therefore the present study aims to determine the training needs of nurses related to the utilization of mechanical ventilators.

In this descriptive study, 98 nurses working at emergency departments of top rated hospitals of Iran University of Medical Sciences filled the questionaire. This researcher designed questionaire included demographic data, evaluation of knowledge in the format of scenario, evaluation of attitude and a paper of skill checklist , were used after validity and reliability confirmation. Analysis of data were done by SPSS version 22 and parameteric and non-parameteric tests.

Most of the nurses participanting in this study were female (86.7%) and in the age group of 25 to 35 years. Among them, 74.5% of ED nurses had work experience less than 1 year in the Intencive Care Unit (ICU), and 51% hadn’t passed ED nusing course. The most training need in the area of knowledge included patients intubation; in the area of skill included setting the ventilator’s parameters and in the area of attitude included fear of taking care of patients under ventilator.

According to the results of need assessment, it is mandetory to pay attention to the problems and demands of nursing in their educational programming. In order to meet profesional needs, short daily educational courses should be held and practical and skill aspects should be considered in training nurses.

Cardiovascular Diseases (CVDs) have been considered to be the leading cause of morbidity and mortality throughout the world. Various factors such as occupational and environmental risk factors affect CVDs. Nowadays, shift work is considered to be an occupational stressor. Previous studies have shown conflicting results regarding to the relationship between shift work and cardiovascular diseases. The aim of this study was to determine the relationship between shift work and the risk of cardiovascular diseases based on the Framingham Risk Score among nurses working in hospitals associated with Abadan Faculty of Medical Science during 2019.

This study is a descriptive-analytic study which has been conducted on 120 nurses divided to 60 shift workers and 60 day workers working in hospitals associated with Abadan Faculty of Medical Science. The participants were selected through stratified random sampling technique. Data were collected using two-section tools including demographic data (smoking and medical and occupational history) and the Framingham Risk Score which were collected through check lists and interviews. Blood pressure (BP) was measured using a digital measuring device. The participants' blood pressure was measured by standard method and two month follow-up. Measurements were taken at the beginning and end of the shift. Blood Total Chol and HDL were measured in a 5cc intravenous blood sample after 10-12 hours fasting time and were measured by standard laboratory technique. In all the tests, a confidence level of 95% and a significance level less than 0.05 was considered. Data were analyzed by descriptive and inferential statistics using SPSS version 22.

According to the results of this study it can be concluded that the mean age shift workers and day workers were 32.20±2.97 and 37.43±2.90 respectively. Also, job experience in shift workers and day workers were 8.40±4.42 and 14.10±3.12 years respectively. There was a statistically significant difference between prevalence of CVD risk and shift work based on Framingham Risk Score (p=0.04).

The results of this study revealed that shift work is a risk factor for CVD disturbances. These findings may be of use for nurses and other relevant authorities for screening and even preventing CVD

Multiple organ dysfunction syndromes are extremely common in the ICU. The failure of different organs including the heart, kidney, lung and circulation has prompted specialists to consider replacement therapies. Treatment programs in the intensive care units focus on two main goals: 1- Correcting numbers and clinical conditions 2- Fixing the underlying problem. This fundamental question raises that can the outcomes be improved by the remediation of clinical conditions and replacement therapies until the underlying problem is eliminated? This study evaluated the scientific evidence for some of these replacement therapies. Despite the good effects of replacement therapies, still it cannot well manage the multiple organ dysfunction syndrome. To conclude it can be stated that the current treatments are not the best option, but they are the best available one at the moment. Perhaps this critical point may lead to a new mindset in identifying the pathophysiology of critical illnesses and as a result may provide appropriate therapeutic strategies.