نشریه پرستاری مراقبت ویژه
سال دوازدهم شماره 4 (پیاپی 44، زمستان 1398)

Hospital emergencies are of particular importance as they are considered as the first-line treatment for patients. Patient mortality in the emergency department is considered to be a problem as it has intensified in recent years. The aim of this study was to investigate the causes of mortality in patients admitted to the Emergency Department of Imam Khomeini Hospital in Urmia in the first half of 2017.

In this cross-sectional descriptive study, after obtaining permission, the medical file of all those patients who had referred to the emergency department during the period of April 1st to September 31st, 2017 and who had died in the emergency for any reason was gathered. Data were collected from the archive and were collected for variables such as age, sex, marital status, residence, initial complaint, length of hospital stay, visitation service, place of death and cause of death.

A total of 133 cases were studied, of which 77 (57.9%) were male, 114 (85.7%) were married and 71 (53.4%) were residents of Urmia and the mean age of patients was 66/8±18/9. The most common complaints reported by patients or their companions were about consciousness loss and the least reported were chest pain, hematuria, and lower extremity swelling, respectively. A high percentage of mortality (58.6%) had occurred in patients who had been in the emergency department for 24 hours or less. The most common causes of mortality were cardiopulmonary deaths and cardiovascular disease, and ultimately in the evaluation of the duration of the disease (acute or chronic), 38 (28.6%) had acute disorder and 95 (71.4%) had a previous chronic disease.

According to the results of the present study, most of the causes of mortality included cardiopulmonary arrest and cardiovascular problems. These findings reveal the  importance of controlling and preventing these diseases and on the other hand, shows the necessity of proper planning, staff training and equipping the emergency departments in order to reduce mortality rates.

One of the most important problems in the intensive care unit patients is the increase  sensory over load. Delirium and agitation are its consequences. The aim of this study was to evaluate  the effect of using non-invasive methods such as the use of eye masks and earplugs on the level of agitation  and the prevalence of delirium in hospitalized patients in intensive care units.

Present study was a randomized clinical trial of two groups of 88 patients admitted to the intensive care unit of Besat Educational and Medical Center in Hamadan in 2017. Patients were randomly divided into two groups:  intervention and control. The intervention lasted from the second night for seven nights. In the intervention group for patients from 10 pm to 6 am simultaneously, eye mask and earplug were used and in the control group, no special intervention was performed. To measure the incidence of delirium, the CAM-ICU questionnaire and the RASS questionnaire were used to assess the level of agitation.

The results of this study showed that patients in both intervention and control groups did not differ in terms of demographic characteristics, room conditions and hospitalization reasons. The results also showed that the use of instruments such as earplug  and eye plug  significantly reduced the level of agitation  (based on the RASS scale) in the intervention group compared to the control group (P = 0.001). Also, the incidence of delirium based on CAM-ICU scale in the intervention group had a significant reduction rather than control group (P <0.001).

The use of eye mask and ear plug can reduce the incidence of delirium agitation of hospitalized patients in the intensive care unit

Family members of patients admitted to cardiac care units experience high levels of anxiety which can cause mental and physical problems. This study aimed to determine the effect of face to face information support on the anxiety of the family members of patients admitted to the Cardiac care unit has been assessed.

This quasi-experimental study was performed on family caregivers of patients admitted to cardiac care units in Sevome Shaban Damavand Hospital In 2019. Sixty family caregivers were divided into two groups of 30 intervention and control groups. Family caregivers of the intervention group received information support such as a face to face presentation content as a training booklet. The control group received the educational brochure. Both groups completed the demographic information form. The HADS questionnaire was completed in two stages.

The mean and standard deviation of the intervention and control groups anxiety scores were 8.53 (SD=2.46) and 7.70 (SD=2.29) respectively before the information support. The two groups had no significant difference in the level of anxiety before the intervention. After the intervention in the control group, at each stage, the mean score did not change significantly 7.07 (3.51), but in the intervention group the mean anxiety score decreased 5.75(6.62). However, the difference was not statistically significant (P=0.25). However, it was significant with the time group Generalized Estimating Equation test (P=0.001). This suggests that intervention has a facilitating role in reducing anxiety.

 Using information support is effective in reducing anxiety in family of patient of cardiac care unit.

 Sudden and unexpected death on one hand, and the crucial decision over organ donation on the other hand, can severely affect the mental health status of the family members of brain death patients. The purpose of this study was to investigate the psychological health status of the family members of the patients with brain death and organ donators.

 In this cross-sectional descriptive study, the target population included all immediate family members of the patients with brain death who had agreed on organ donation. For this purpose, 50 individuals were selected as the sample of the study based on available sampling method. The instruments used in this study were the Mental Health Questionnaire, Beck Depression and Anxiety Questionnaire and Grief Experience Questionnaire.

The results showed that the level of grief and anxiety of the participants was moderate (52% and 38%, respectively). Most of the participants (50%) experienced moderate depression. In terms of general health, half of the subjects were reported to have poor or very poor health indices. The findings also showed that there is a positively significant relationship between the scores of grief and anxiety and depression (p < 0.001).

Based on the results of this study, it can be concluded that people who have given consent to organ donation are not in good psychological conditions. Therefore, it is recommended that the psychology team provide psychological programs to those family members in order to improve their psychological conditions.

Chest tube removal is one of the most anxious events in Intensive Care Unit patients. Reflexology foot massage is considered to be one of the non-pharmacological approaches that has been the focus of researchers in patients undergoing open heart surgery due to the reduction of complications and costs. The purpose of this study was to evaluate the effect of foot reflexology massage on patients' anxiety during chest tube removal after open heart surgery.

This double-blind, three-group, randomized, controlled, clinical trial study was conducted in Baqiyatallah and Jamaran hospitals in Tehran, Iran in 2013-2014. Eighty-eight patients were selected by convenience sampling method prior to chest tube removing and were randomly allocated in six-blocks into three groups: intervention (10 minutes center and anterior one-third reflective massage of foot (n=29), placebo (one-third posterior surface contact of patient's left foot (n=30), and control (routine care (n=29). Before intervention, the Spielberger anxiety test was completed in all three groups. This test was again immediately recorded after removing the chest tube. Data were analyzed by SPSS software version 18 and descriptive and inferential statistics.

Based on the results of this study, the mean difference of quantitative variables including age, height, weight and body surface, and qualitative demographic variables including educational status, occupation, and marital status were not significantly different between the three groups before intervention (P>0.05), indicating that the samples were homogeneous before the intervention.  Paired t-test showed a statistically significant difference between the two groups so that the level of situational stress decreased post-removing the tube in the intervention group (P<0.003) but significantly increased in the placebo and control groups (P=0.025, P<0.001), respectively.

According to findings it can be stated that foot reflexology massage significantly reduces anxiety in patients undergoing chest tube removal after open heart surgery and as a result is a useful nursing intervention in patients undergoing chest tube removing procedure after open heart surgery. Actually, with minimum costs and no side effects this technique can improve the level of care for these patients in the critical phase of recovery after open heart surgery.

In hospitals, it is usually practice with patients presenting in cardiac arrest for family members to be taken outside of the resuscitation room; And family members are informed about the patient’s situation periodically by a team member. One of the issues discussed in many countries, including Iran, is the presence of family during resuscitation, which is not seriously implemented in Iran. Nurses' self-confidence is considered to be one of the effective factors in accepting and implementing this process by nurses. The aim of this study was to evaluate the correlation between the work experience of emergency nurses and their confidence during the family presence of patients while resuscitation.

This study was carried out in 7 teaching hospitals of Tabriz during three months (June to August 2019). For this purpose, 140 nurses were selected through stratified random sampling method. Nurses' demographic and self-confidence questionnaires about family presence during resuscitation were used.

The mean score of the participants’ age was 30.87±7.05. The majority of nurses was female and had a bachelorette degree in nursing. About half of the nurses (46.42%) had less than 5 years of work experience.  However, the mean confidence scores of nurses were 52.91±12.69 which was in a moderate level. Nurses with more work experience, had higher levels of self-confidence. This is while nurses with less than 5 years of work experience  had less self -confidence than nurses with 11-20 years (P = 0.025 and F =3.200) of work experience.

According to the findings of this study it can be stated that nurses who have higher levels of self-confidence are more prepared for family presence during resuscitation. Therefore, it is recommended that nursing and hospital managers engage highly experienced and confident nurses in the emergency departments in order to provide family centered care more effectively.

Patients undergoing mechanical ventilation have verbal communication deficits due to endotracheal intubation. As there is s trend towards light sedation patterns nowadays, communicating is considered to be one of the major challenges for these mechanically ventilated patients. The purpose of this study was to describe the communication experiences of mechanically ventilated conscious patients in the intensive care units.

In this study, the phenomenological method was used to explain the experiences of conscious patients undergoing mechanical ventilation communication in the intensive care unit of Imam Khomeini Hospital in Urmia. For data collection, 10 participants who had at least 24 hours of mechanical ventilation consciousness in the intensive care unit were interviewed over a 6-month period in 2019-2018. The researchers used the Colaizzi method to analyze the data and in order to facilitate the classification of the primary codes, the MAXQDA version 10 software was used.

From the primary codes, the two main themes of "psychological suffering" and "resilience" were formed. The main themes of psychological suffering included the sub-themes of "fear of deprivation" and "being ignored by others" and the main theme of resilience included the sub-themes of "understanding the role of care providers and family" and also the "use appropriate alternatives".

Mechanically ventilated conscious patients are in an effort to increase communication, and when health providers continue to communicate with these patients, a sense of hope, increased levels of self-esteem and controlling conditions is developed in patients.