نشریه پرستاری مراقبت ویژه
سال سیزدهم شماره 1 (پیاپی 45، بهار 1399)

Intensive care units encounter with the complex and different therapeutic and care needs of patients. The effective responsiveness to these needs depends on the knowledge and skills of different health professions, so inter-professional collaboration and teamwork is essential to providing safe and comprehensive care in these areas. Inter-professional collaboration is a process in which different health professions, along with the patient and their families work together in the interaction based on partnership, mutual trust and understanding, information sharing, common goals setting and joint decision making to achieve the best and most effective outcome for the patient. Unfortunately, most current performance in the intensive care units is parallel, independent and without the participation and joint decisions of different professions, and this is one of the reasons for the increase the medical errors and negative patients’ outcome. Numerous factors, including systemic, organizational, and interpersonal interactions, are influential on inter-professional collaboration in the mentioned wards, and understanding them will provide an opportunity to promote inter-professional collaborations in these areas. Strategies such as inter-professional rounds, the development of inter-professional common goals setting sheets, the preparation of guidelines, as well as the tools for measuring team performance and monitoring them can be effective in promoting inter-professional collaboration in intensive care units. It is time to adopt approaches and strategies to improve teamwork and inter-professional collaboration in intensive care units and improve patients’ outcome.

During hospitalization patients in the ICU, many family members are at risk for a mixture of negative psychological reactions. This study aimed to review the symptoms and challenges of these families and to give caring strategies for ICU family members.

This review study was done through a library literature review in the scientific data bases including Google Scholar, Science Direct, Scopus, PubMed, SID, Magiran, and Iran Medex. All articles in English and Persianpublished between 2002 and 2019 were studied. After screeing the articles according to the inclusion criteria, 27 articles were analyzed.

The family members of critically ill patients admitted to the ICU often experience a cluster of adverse psychological reactions in response to conditions that is out of their control. These experiences have been recognized as “intensive care syndrome-family”. Family-centered care and effective communication were mentioned as the most important and effective strategies to reduce the complications of this syndrome.

As a key member of the health care team in the ICU, nurses  not only are responsible for the patients, but are responsible for the family members. They should help families to cope with the crisis of ICU admission and help prevent or control the family intensive care syndrome in them through family-centered care measures.

Gastrointestinal complications after open heart surgery are high mortality despite having low incidence. One of the complications that can overshadow the surgical results is constipation. Fasting before surgery and delayed oral nutrition after surgery are the causes of constipation. The aim of this study was to investigate the effect of nutritional guidelines on the prevention of constipation in patients undergoing open heart surgery.

A special nutritional care instruction was designed using a review and Delphi study. In a clinical trial, 70 patients underwent open heart surgery. They were placed in two groups of 35 (experiment and control group). Nutritional guidelines and pamphlets were taught to patients and nurses in the experiment group. Patients were screened for constipation from the day before surgery to one week after surgery. The control group received routine experiment.

The mean frequency of bowel movements in the experimental group was higher than the control group, but only statistically significant in the first two days (P <0.05). Stool consistency was more natural during the one-week postoperative period in the control group than in the control group, and this difference was statistically significant (P <0.05).

The results of this study showed that the formulated nutritional care guidelines can be effective in preventing and reducing gastrointestinal complications, especially constipation, in the first two days after open heart surgery.

Seizure is a common disorder and is also one of the most important reasons for referring to emergency departments of hospitals which has multiple causes. It is believed that early diagnosis of this disorder is extremely important. This study aimed to investigate the causes of the first generalized seizure of adult patients referring to the Emergency Department of Imam Khomeini of Urmia during the second half of 2018.

This study was a cross-sectional descriptive study conducted in the second half of 2017 on all patients suffering with seizure over 18 years of age who had referred to the emergency department of Imam Khomeini Hospital in Urmia by census method. Data were gathered using a checklist which included different variables (age, gender, marriage, and place of residence, education, diagnostic tools, and the ultimate cause of seizures).

The results showed that among the total 120 studied patients, 55 were males (45.8%) and 65 patients were females (54.2%). The average age of the participants was52.50 ±20.42 years and most of the participants were married 86(71.5%) and in the age group over 60 (34.4%) were 52, The procedure of diagnostic tests CBD diff / Na / K / Ca / Bs and ESR / CRP in most cases, diagnosis of the causes seizures and CT scan imaging technique (74.5%) of 89 cases necessary that ultimately the most common cause of seizure disorders The cerebral arteries (28.3%) were 34.

In this study, the most common cause of seizures is cerebrovascular injury, but due to the high prevalence of seizures following trauma, drug deprivation, elimination of underlying factors and social anomalies will be an important step in preventing seizures.

Psychological factors play an essential role in many cardiovascular diseases. This study was designed to predict heart function based on type D personality and depression in patients with acute myocardial infarction.
 
Materials: This research was a correlational study. The statistical population of this study included all 234 patients with acute myocardial infarction ST-Elevation Myocardial Infarction who had referred to Fatemeh Zahra Hospital in Sari city in 2019 which had underwent percutaneous coronary intervention. Using the Cochran's formula, 144 patients were selected by available method and responded to the D personality questionnaire of Denolet and Depression Inventory Short of Beck.

Findings revealed a significant relationship between D personality and depression with heart function [P<0.01]. Also it can be stated that D personality and depression can predict heart function [P≤0.01].

Type D personality and depression play a role in the incidence of heart disease and the prognosis of patients with myocardial infarction. Screening for this personality type along with the depressive disorder in heart function is required by therapists.

Sensory stimulation in patients with decreased levels of consciousness in the Intensive Care Unit (ICU) can affect their level of consciousness, especially if these stimuli are familiar and have meaningful contents. Therefore, the aim of this study was to introduce a "Family Guided Visit program” to increase level of consciousness in traumatic brain injury patients hospitalized in the ICU.

 The study is a clinical trial study. The statistical population was brain-injured hospitalized in the intensive care unit of Al-Zahra (AS) and Kashani Medical Center in Isfahan. In this study, during 7 stages, the "Family Guided Visit Program" was designed, implemented and evaluated. In the design Phase, first, the Program draft was prepared using nursing texts on the needs care  and the role of families in their implementation, then using the RAM technique in terms of concept, usefulness, relevance and applicability of the content by families, the Program was developed. During the implementation Phase, one of the family members who had been trained on the appointment, received hearing and tactile stimulation Patients daily and for 14 days, as scheduled. In the evaluation Phase, the daily level of consciousness was measured 30 minutes before and 30 minutes after the visit, using the Glasgow Coma Scale and the Four-Number Scale.

The research findings showed that the average changes in the level of consciousness based on the four digit scales from the beginning of the study to the end were 6 ± 1.7 in the test group and 1± 1.35 in the control group. The independent t-test showed that these changes in the test group were significantly higher than the control group (P< 0.001). Also, according to the Glasgow coma scale, from the beginning of the study to the end (over a period of fourteen days), the total daily changes shows a statistically significant difference in the average score of patients' level of consciousness between the two groups. (P< 0.001).

A targeted and planned visit by the family is effective in improving the level of consciousness of the injured. Therefore, it is recommended to provide conditions for the family members who are emotionally close to the patient to make appointments with the patient with sufficient training, using this proposed program.

Family members of patients hospitalized in the intensive care unit have significant anxiety. Strengthening the hospital's relationship with the home after discharge can be helpful in providing the necessary information and skills in the presence of the liaison nurse to provide and maintain care. The aim of this study was to determine the effect of the role of the liaison nurse on the family anxiety level of patients discharged from the intensive care unit.

 This clinical trial study was performed on 53 patients discharged from intensive care units in two groups of intervention and control. Patients in the intervention group were followed up for two weeks by a trained nurse as a liaison nurse and the control group did not receive any follow up care. The level of anxiety of the patients' family was completed and assessed by the 14-item Hospital Anxiety Questionnaire at discharge, at the end of the first week and the second week after discharge by the primary caregiver.

The mean score of anxiety in the family intervention group was 10.34 ± 4.01 immediately after discharge and in two weeks after discharge it was 9.10 ± 2.85. In the control group, the mean score of family anxiety immediately after discharge was 9.33± 3.59 and two weeks after discharge was 9.87 ± 4.1. There was no statistically significant differences between the anxiety levels of the control and intervention group immediately after discharge, and one week later and two weeks later (P> 0.05).

Although the results of the present study did not show a significant difference in the anxiety score of family members between the two groups with and without a liaison nurse, the anxiety scores in the liaison nurse group had decreased compared to before discharge. Also, it is worth mentioning that training the primary caregivers of patients discharged from intensive care units can reduce the level of family anxiety after discharge.