نشریه پرستاری مراقبت ویژه
سال سیزدهم شماره 4 (پیاپی 48، زمستان 1399)

The basis of the nursing profession is the observance of ethics in providing care. Therefore, this study aims to investigate providing ethical care to patients with decreased Levels of Consciousness (LOC) and its relationship with the demographic characteristics of nurses in Intensive Care Units (ICUs).

This cross-sectional study was conducted in 2019. The samples included 70 nurses working in ICUs, who met the inclusion criteria for the study and were selected by simple random sampling. The data collection tool was a two-part researcher-made questionnaire including demographic characteristics ( 6 questions) and 38 questions related to ethical care of patients with decreased LOC in two areas of nurse and professional commitment (20 questions), nurse and clinical services (18 questions). Reliability was obtained by internal consistency and Cronbach’s alpha coefficient was obtained to be 0.869. The questionnaire was completed by self-reporting.

The results of the study showed that the total score of ethical care is from 108 to 151 with a mean and standard deviation (125/7± 09/ 67) from 152. This means that all nurses had a relatively high score of ethical care. Statistical tests also showed that there was no significant relationship between demographic variables of samples such as age, level of education, marital status and employment status with the total score of ethical care in ICUs ((P> 0.05).

According to the findings it can be stated that there is no statistically significant relationship between nurses 'demographic characteristics and patients' ethical care with decreased LOC. It can be concluded that nurses, especially nurses of ICUs who care for patients with reduced LOC, regardless of their different types of demographic variables, feel ethically responsible for providing care to their patients and try to provide care services with the highest ethical standards.

The COVID-19 is an emerging global pandemic which has been developed from a new type of coronavirus in the form of a viral infection with high transmissibility and spread. The disease has so far infected millions and killed thousands. Since the outbreak of the disease, many researchers have become interested in modeling and estimating the probable number of infected people with COVID-19 or estimating the mortality rate from this pandemic in a specific period of time and in different countries. These models make it possible to better understand the behavior of this pandemic and predict its trend. This study aimed to model the mortality rate due to the COVID-19 pandemic in five consecutive months in Iran.

The Autoregressive (AR) model and the Autoregressive Moving Average (ARMA) model were analyzed to test the ability of these models to estimate the mortality rate of COVID-19 disease from March to July. The performance of these models was evaluated with three criteria: mean square error, cost function, and final prediction error. The models were evaluated on the number of deaths confirmed by the Iran Ministry of Health and Medical Education.

The results of the analysis showed that the AR model with a rank of ten was successfully able to predict the mortality rate of COVID-19.

The proposed model can predict the death rate of the COVID-19 pandemic. Estimating the mortality rate of the COVID-19 pandemic helps to better understand the behavior of this disease and predict its trends, which affect the type and timing of actions to control it.

Most critically ill patients admitted to intensive care units need to be transferred to perform diagnostic and therapeutic procedures. This transfer can be associated with adverse events such as disorders of various cardiovascular systems, respiration and nerves. The purpose of this study was to determine the incidence of adverse events related to physiological changes during transfer from Intensive Care Units (ICU) in Jahrom Pimanyani Hospital, Jahrom, Iran.

In this descriptive cross-sectional study, data on patient transfers from the ICU of a university hospital were collected from 9 February 2019 to 10 August 2019. Descriptive and analytical statistics indices were analyzed by SPSS software 22.

Out of 588 cases of transfer, 536 patients (91.2%) had adverse events. Actually, 351 (65.5%) of the adverse events were related to physiological changes in the body. The most common adverse events in cardiovascular, respiratory, gastrointestinal, and endocrine systems included an increase of heart rate(≥ 20)  by 15.9%, a 5% decrease in SPO2 for more than one minute by 32.5%, agitation by 15.1%; vomiting by 15.1% and hypoglycemia by 0.2%.  The most common adverse event was increased pain by 11.4%. The results of chi-square test showed that there was a significant relationship between gender and the incidence of adverse events (p-value = 0.035).

The results showed that the incidence of adverse events during the transfer is high, which can be due to lack of equipment needed during the transfer, illness of patients and also human errors due to inadequate training of the transfer team. It is recommended to help reduce the incidence of adverse events by standardizing the equipment needed during the transfer as well as giving necessary training to the transfer team. The existence of numerous and serious physiological deficiencies of patients in need of special care is indicative of numerous managerial and organizational problems that are in conflict with the safety of patients at risk.

One of the debates in psychology is the relationship between physical illnesses and the resulting psychological and psychological phenomena that can cause extensive harm to the individual. The purpose of this study was to investigate the relationships of the behavioral brain system and anxiety sensitivity with psychosocial vulnerability in people with asthma who are under intensive care.

The method of this study was descriptive-correlational based on Structural Equation Modeling. To determine the sample size according to the number of observed variables and allocating a coefficient of 10 for each observed variable (24 variables observed in the model), and considering the probability of incomplete questionnaires, 250 people were selected as the target sample. The used instruments included the Brain Behavioral System Questionnaire, Psychological Vulnerability Questionnaire and Anxiety Sensitivity Questionnaire.

The results showed that the behavioral brain system through anxiety sensitivity has an impact on the psychiatric vulnerability of asthmatic patients and the effects of direct and indirect pathways 74 percent of the variable of psychological vulnerability can be explained by the brain behavioral system and anxiety sensitivity. In general, the research model was approved.

Considering the presence of psychological factors in asthma and identifying the role of emotional and anxiety factors in the extent of mental injury in patients, it is recommended that therapists consider protocols based on cognitive behavioral patterns in these groups of patients.

Eye care in Intensive Care Units (ICUs) prevents eye diseases and vision loss. However, as preserving vital organs in patients who are hospitalized in ICUs seems to be more important than eye care, this important issue is often overlooked. There is also disagreement about eye care methods, and sometimes nurses provide eye care based on their personal opinions rather than standards. This can lead to keratitis in patients. Therefore, this study has been designed in order to compare three eye care methods for preventing keratitis in patients who are hospitalized in ICUs.

The present study is a double-blind clinical trial that was performed on 74 patients who were admitted to the ICU in 2018. Each patient was randomly assigned to one of the eye care groups by simple random method (dice throwing). For the first intervention group whose dice outcomes were 1or 4, the ointment and anti-allergy adhesive methods were considered. For the second intervention group with dice outcome of 2 or 5, eye ointment and artificial tears methods was considered and for the third intervention group with dice outcome of 3 and 6, anti-allergy adhesive methods and artificial tears were applied. Every eight hours the patientschr('39') eyes were washed with distilled water and cotton and the eye care was renewed. Their eyes were examined by an ophthalmologist on the first day and at the end of the seventh day using a fluorescein test.

At the end of the study, 60 eyes (30 patients) were analyzed. The incidence of ocular keratitis was the same in each of the three groups. Therefore the use of simple eye ointment, eye care by anti-allergic adhesive with a width of 1.25 and eye care by artificial tear method had no significant effect on the incidence of keratitis. Also, except for four cases, two of which were related to eye care with anti-allergic adhesive and two of which were related to eye care with artificial tears, that were not statistically significant, there were no reports of keratitis and eye involvement.

Eye care with simple eye ointment can be more effective in maintaining corneal health than the two methods of using adhesive and artificial tears, although this difference was not significant. It seems that keeping a constant amount of moist for eyes, in addition to keeping the eyelids closed, can prevent the occurrence of eye complications and disorders in patients that are admitted in ICUs and have a reduced level of consciousness.

Providing nursing care that has the least complication and highest efficacy in ill patients is the most important goal in nursing care. This study aimed to investigate the effect of music on the physiological indices of traumatic patients admitted to trauma Intensive Care Units (ICU) in Qazvin. Actually, this study was carried out in order to examine the efficacy of music as a simple and uncomplicated intervention in improving the physiological symptoms of abnormalities, thus helping to improve nursing care and reduce hospitalization time.

This study was a clinical trial with code of ethics IR.QUMS.REC.1397.276. The study population consisted of traumatic patients admitted to trauma ICU in Qazvin in 2018-2019. Patients with inclusion criteria were selected based on the Stress Pain Sampling and were randomly assigned into control (n=27) and intervention (n=27) groups. In the control group, only routine day care was performed for the patients. In the selected music test group, the patients received headphones for 15 minutes during seven days. The data collection tool in this study was three questionnaires: a) demographic information questionnaire and b) checklist of vital signs status. Data were analyzed using SPSS Version 23 software  and descriptive and inferential statistics tests (independent t-test, Mann-Whitney, Chi-square and Fisher exact test). The significance level of all tests was considered p <0.05.

In this study, 54 samples were included in the statistical analysis. Demographic characteristics were not significantly different between the two groups (p> 0.05). After the intervention in the sixth and seventh days of the study, there was a statistically significant difference in the mean pulse rate, respiratory rate and blood oxygen saturation in the two groups (P <0.05). In regards to the temperature of the patients, there was no statistical differences between two groups (p> 0.05).

The results of this study showed that gentle music play for 15 minutes during seven days increase oxygen saturation and decrease pulse rate, respiration, blood pressure but does not affect body temperature. Music seems to be a cheap, safe and easy intervention for coma patients with critical conditions as a viable solution to improve the status of their vital signs.

Hospitalization in Intensive Care Units (ICU) causes sleep and comfort disturbances in patients and has an adverse effect on the recovery process of these patients. One of the factors affecting sleep and comfort of patients is ambient noise. This study aimed to determine the effect of the white noise on sleep quality and comfort of patients.

The present study was a randomized, double-blind clinical trial with 60 patients undergoing open heart surgery who had admitted in the ICU in Hamadan in 2018.Patients in the experimental group selected one of the three sounds of rain, sea and river waves and played them with headphones for three nights for 20-30 minutes. The control group did not receive any intervention. The sleep quality of patients was measured using standard St Marychr('39')s Hospital Sleep Quality Questionnaires and VAS.  

The results showed that there were no differences in demographic and clinical characteristics (nausea, medications, type of surgery, length of stay, duration of surgery) in the control and experimental groups. The results also showed that using white noise significantly reduces sleep disturbance and increases comfort in the experimental group compared to the control group (P <0.001).

The use of white noise such as the sound of sea waves, river sound and rain in ICU patients after open heart surgery reduces their sleep disturbance and increases their comfort.