نشریه پرستاری مراقبت ویژه
سال سیزدهم شماره 2 (پیاپی 46، تابستان 1399)

Ventilator-Associated pneumonia (VAP) is one of the prevalent nosocomial infections and the most severe Acquired infection in intensive care units (ICUs) [1]. VAP usually occurs forty-eight hours after the starting of mechanical ventilation. This infection has several complications, including hospital long stay, high medical costs, high antibiotic use, and high mortality rates [2,3]. The prevalence of VAP in developing countries is more than that in developed countries [2]. Despite recent advances in diagnostic and therapeutic methods, VAP has remained a common infection and a major cause of mortality in the ICUs [2,3]. VAP affects approximately 27% of critically ill patients in ICU wards [2,3]. Prevention of VAP is a significant challenge for workers in intensive care units and should be considered as a priority. There are some strategies to prevent VAP, such as appropriate sedation and early weaning, semi-seating position, oral hygiene, applying noninvasive positive pressure ventilation (NPPV), tracheal secretion management, nurses hand hygiene, selective decontamination of the digestive tract, appropriate antibiotic therapy, and subglottic secretion suctioning [2,4,5]. Another under attention approach to preventing VAP is to ensure adequate pressure of endotracheal cuff. Tracheal cuff pressure should be maintained in the accurate range (20–30 cm H2O), and under inflation and over inflation can be associated with the risk of aspiration and tracheal injury [6,7]. Micro aspiration of subglottic secretions due to cuff under Inflation is one of the most critical risk factors for the VAP [4], Therefore, ensuring adequate pressure of cuff to prevent micro aspiration is a low-cost, easy, and practical approach in VAP prevention. However, the importance of this technique in guidelines and studies is under attention. Various methods are used to assess the accuracy of tracheal cuff pressure, including manual (Minimal leak and Finger Palpation) and automatic (Direct Manometer and Continuous Monitoring) methods. Two common methods for checking the accuracy of cuff pressure are the manual method (Minimal leak) and the use of direct manometer [6]. Studies showed that continuous monitoring of cuff pressure could also be more efficient in VAP prevention [1,4]. Given the importance of this issue, the design and implementation of the guillotines to assess and ensure adequate cuff pressure along with other measures is necessary and can help to prevent VAP.

People's jobs are one of the most important sources of stress. There is more stress in medical jobs. Nurses, especially nurses in intensive care units, are faced with many occupational stressors that use many strategies to cope with them. Identifying the type and extent of coping strategies used by nurses in the face of occupational stress can be useful in their educational planning in order to employ appropriate coping strategies. Therefore, the present study aimed to determine coping strategies with job stress of nurses working in intensive care units of hospitals in Tehran.

This research is a descriptive-cross-sectional study that was conducted in 2019 in Tehran. In this study, 5 university hospitals that had intensive care units were selected by cluster random sampling and then all nurses working in special wards that were consciously willing to participate in the research and were eligible were examined by census and 235 people. Data were collected using demographic questionnaires and countermeasures (Lazarus-Folkman) and analyzed.

The results showed that the majority of nurses (75.3%) had poor coping strategies (65.81±14.34). Nurses mostly used problem-centered coping strategies (47.72±11.13). Positive reappraisal subscale (51.55±14.80) of problem-centered coping strategies and restraint subscale (45.79±12.92) of emotion-focused coping strategies were used more frequently by nurses. There was a statistically significant difference between demographic characteristics and age of coping strategies (P=0.037).

According to the results of the present study, it seems necessary to educate nurses about the optimal use of coping strategies.

Patients with acute coronary syndrome suffer from severe consequences such as relapse and readmission due to insufficient comprehension of educational content and subsequently failure in treatment adherence. Using some strategies in order to improvement of their knowledge and comprehension about taught content may be effective on disease outcomes. The current study aimed to determine the effect of teach-back education on readmission in patients with acute coronary syndrome.

In this randomized clinical trial, 70 patients with acute coronary syndrome admitted to the cardiology and cardiac care units of two Hospitals in Zahedan were selected conveniently in 2019. Then patients were randomly assigned to intervention and control groups through using color cards. Data collection tools included demographic information form and a form for recording the readmission. Intervention was based on teach-back education method during three sessions of 30-45 minutes individually and 24 hours after admission to the hospital. Three months after the intervention, readmission was assessed. Data analysis was done through descriptive statistics, independent t-test and chi-square test in SPSS21.

Results showed there was no significant difference between two groups in terms of some variables such as age, gender, educational level, marital status and diabetes history (P>0.05). In intervention group,14.3 percent of patients and in control group 37.1 percent reported readmission during three months after the intervention and there was significant difference between the two groups in terms of readmission (P=0.029).

Teach-back education reduces the cases of readmission in patients with acute coronary syndrome. Given the importance of nurses' role in education, this educational method can be used to improve disease outcomes.

Many patients undergoing aggressive medical interventions, such as cardiac electrophysiology studies, experience anxiety on the operation day, which can affect patients' psychological and physiological issues. This study aimed to investigate the effect of guided imagery on anxiety and vital signs in patients undergoing cardiac electrophysiology studies.

This study was performed as a double blind randomized clinical trial study. The statistical population included 52 patients who were candidates for cardiac electrophysiology study in Rasht. They were divided into two groups of intervention (n=26) and control (n=26) through simple randomization. Before and after the intervention, the Spiel Berger state anxiety inventory questionnaire was completed and their vital signs were recorded. For the intervention group, one day before and one hour before the electrophysiology studies, a guided audio visualization CD was delivered through headphones for 18 minutes.

The results showed that there were no significant differences between the two groups in mean blood pressure score, respiratory rate, body temperature, and heart rate before and after the intervention (p >0.05). The severity of hidden anxiety score was significantly different between the two groups after the intervention.  No meaningful difference was observed between the two groups in regards to the other variables such as obvious anxiety score before and after intervention and the hidden anxiety score before intervention(p >0.05).

Guided visualization was effective in controlling both open and hidden anxiety in patients undergoing the electrophysiology studies but had no effect on patient's vital signs.

The emergency department is one of the most important wards in a hospital. This study was conducted with the aim of evaluating the performance indices in emergency departments of hospitals before and after the establishment of the emergency medicine group.

In this cross-sectional study, the performance indices in the emergency departments of hospitals were extracted before and after the establishment of emergency medicine groups from the archive of these hospitals.  

This study showed that the presence of the emergency medicine group in the hospital had no effect on the performance indicators of the emergency department, but the establishment of the emergency medicine group in Khatam al-Anbia Hospital reduced the rate of unsuccessful CPR, the rate of hospitalization with personal satisfaction and the average triage time in Levels 3, 4 and 5 are triaged. According to the results of this study, the percentage of unsuccessful CPR did not differ during the year in the hospital, but its percentage decreased after the establishment of emergency medicine in the hospital.

According to findings it can be concluded that the establishment of emergency medicine groups in hospitals improved their performance indices.

One of the main reasons for the poor performance of emergency nurses in providing care to trauma patients is the lack of readiness, knowledge and relevant skills of them. It is important to have a periodic evaluation of the readiness of emergency nurses. The aim of this study was to determine the readiness of emergency nurses in the care of trauma patients based on the ATLS index and related factors.

In this descriptive-cross-sectional study, 230 nurses working in the emergency department of three hospitals affiliated to Qom University of Medical Sciences participated with an easy and convenience sampling method in 2019. Data were collected using demographic information tools and nurses' readiness to care for a trauma patient. Readiness tools included areas such as triage, primary assessment, secondary assessment of head-to-foot, and trauma patient care in special circumstances. The overall score of the preparation and each of its areas were 1-5. Data analysis was performed using SPSS software version 22 and descriptive statistics and independent T-tests, ANOVA and Pearson correlation coefficient. The statistical significance level for all tests was considered to be 0.05.

The mean and standard deviation of the readiness of emergency nurses score was 3/55±0/60. The "triage" and "abdominal examination" in the secondary assessment was the weakest (mean 2.87) and "stripping the patient's body and assessing the whole body" (mean 4.19) in the primary assessment and "caring for trauma patients with special conditions" was the strongest area for nurses' readiness. Nurses' readiness was significantly associated with education, sources of information, passing educational courses, age, general and emergency work experience (P<0/05).

The readiness of emergency nurses to care for trauma patients was more than two-thirds of the total and was considered as good scores. Nursing service managers should design and implement training programs to strengthen nurses' weaknesses and ultimately increase the quality of nursing care and the safety level of trauma patients.

The quality of patient and nurse care varies. Differences can be influenced by factors such as the type of department, individuals’ beliefs, and rules. Nurses play an important role in providing care in intensive care units. Qualitative studies are very helpful in identifying the challenges and obstacles in the way of care. Therefore, the present study was conducted to identify nurses' experiences of nursing care in the intensive care unit.

Materials: 

This was a qualitative research using conventional content analysis. Based on purposed sampling 15 nurses, head nurses and supervisors participant which working in the intensive care unit. Data were collected through individual and semi-structured interviews. The data were analyzed based on Graneheim and Lundman proposed method.

Three categories and six subcategories were extracted. The "working nature of the ward" with two sub-categories of working conditions and the structure of the ward, the "safe care" with the two subcategories, sustain standards and optimal conditions, and the "unsafe care" included two subcategories of negligence and ignorance.

Data analysis showed that in order to provide optimal care, while paying attention to the nature of the intensive care unit, the role of safe care should also be considered.