نشریه پرستاری مراقبت ویژه
سال پانزدهم شماره 1 (پیاپی 53، بهار 1401)

Dear Editor Patients in the hospitals are exposed to numerous accidents and disasters (1); One of the most important measures after the occurrence of accidents is the emergency evacuation of the affected area to temporary shelters and the provision of relief services (2). In the past, the need for emergency evacuation in most hospitals was considered a far-fetched phenomenon (3). The process of emergency evacuation of the hospital is extremely difficult and complex, and the transfer of patients in case of emergency evacuation and the continuation of medical services is an important challenge, especially in intensive care units such as hemodialysis (4). Hemodialysis is the most common treatment for end-stage chronic renal failure in Iran and the world. Hemodialysis increases the life expectancy of patients but at the same time imposes many limitations on these patients (5). In case of emergency evacuation of the hospital, hemodialysis patients who are receiving continuous medical services in the hospital will face more problems. A key factor in safe and rapid emergency evacuation of the hemodialysis ward is the readiness of the staff (6). The experience of one researcher showed that nurses face many challenges when there is a fire in the hemodialysis ward. The inability to extinguish the fire and spread to the inpatient wards led to the issuance of a complete emergency evacuation order. The main concern of the nurses of the hemodialysis ward was the sudden interruption of the hemodialysis process and the safe departure of patients connected to the device from the accident site. The difficulty of the transfer process is from the lessons learned from the hospital emergency evacuation. Timely, effective and safe evacuation of patients is a prerequisite for safe emergency evacuation in the hospital, but many dialysis service providers have received little or no training for emergency evacuation. Lack of expertise of hospital managers and firefighters to respond effectively to accidents in hemodialysis wards and on the other hand, lack of experience of personnel for rapid transfer of patients makes emergency evacuation conditions in hemodialysis wards more difficult. Because hemodialysis wards are located in advanced medical centers and receive a large number of patients daily, firefighting and emergency evacuation exercises are rarely performed. According to the clinical experiences of researchers, a very important point in the emergency evacuation of the hemodialysis ward is the continuation of the treatment of the patients connected to the hemodialysis machine. Any delay in the treatment plan of hemodialysis patients will cause health problems. Therefore, it is suggested that the following items be emphasized to reduce the challenges of hemodialysis patients in the emergency evacuation process of the hospital. 1. Paying attention to structural and non-structural resilience of hemodialysis wards against fire and earthquake accidents 2. Providing a suitable bed for easy movement of hemodialysis patients in the ward design 3. Access to mobile and removable hemodialysis units 4. Laying the groundwork for new hemodialysis approaches such as home hemodialysis, ambulance design with hemodialysis system 5. Training of staff of clinical wards, especially hemodialysis wards in the field of firefighting and emergency evacuation 6. Performing firefighting and emergency evacuation exercises in hospitals

Chronic Obstructive Pulmonary Disease patients are certainly the most challenging ones for weaning from mechanical ventilation. Mortality in these patients compared to others due to failure in the weaning process is more than seven times. The present study was performed on the population of ventilated chronic obstructive pulmonary disease purposes of determining cut-off points of New Integrative Weaning Index (NIWI) and conventional indexes and comparing differences between their predictive components.

The observational prospective, triple blinded study was conducted in 2012-2013 on 180 hospitalized COPD patients in critical care units of selected hospitals in Tehran in two groups including cut-off points determining group and determining different predicting weaning factors group. The process of weaning was based on the same and defined protocol. The ROC analysis was used to determine the cut-off points group and the predicting factors were used in the other group.

The highest area under the curves was devoted to Rapid Shallow Breathing Index (0.927) and NIWI (0.878). The highest sensitivity was related to NIWI with 100% and the highest specificity was related to RSBI index 90%, the positive predictive value to RSBI Index was 87.5%, the negative predictive value to NIWI with 100% and highest diagnostic accuracy related to RSBI was 98.67%. The cut-off point and the most desirable components predicting weaning were RSBI, NIWI, P0.1, and NIF indexes, respectively.

The NIWI index can be used as a complementary predictive indicator for weaning from mechanical ventilation in chronic obstructive pulmonary disease patients due to its good predictive components.

Deep Vein Thrombosis (DVT) is one of the most common problems in Intensive Care Units (ICU). The aim of this study was to investigate the relationship between clinical and demographic characteristics with lower extremity DVT in patients admitted to ICU.

The present study is a retrospective case-control study that was performed on 504 patients admitted to the ICUs of Al-Zahra Hospital in Isfahan during 2014-2019. Samples were easily included in the case group (89) and in the control group (415), randomly. Data were collected using a two-part questionnaire of demographic and clinical characteristics, then descriptive and analytical statistical tests such as two-sample independent t-test and if necessary Mann-Whitney were used and were eventually analyzed with SPSS version 21.

The results showed that the mean age of participants was about 53 years, although the mean age in the case group was higher than the control group (p=0.004), but after controlling sex and underlying diseases, had no effect on thrombosis (0.075). The chance of developing thrombosis in men was 1.7 times higher than women (p=0.029). The pao2 / fio2 index in patients with thrombosis (0.61±0.02) was significantly lower than the control group (5.5±2.1) (p<0.0001). After controlling for the effect of age and sex, the chance of thrombosis in patients with hypertension, diabetes, pulmonary embolism and previous history of thrombosis (p<0.0001), 2.6 (p<0.0001), respectively, 3.3 (p=0.006), 1/2 (p<0.0001) 8.1 (p<0.0001) was 36.3. Inactivity with a chance of 29.9 (p=0.0001) was the most important risk factor in ICU for thrombosis.

The results of this study show that having certain characteristics and having some underlying diseases due to which patients are admitted to special wards, increases the chance of developing DVT. Therefore, nurses can pay more attention to them in preventive planning and reducing their incidence.

The widespread prevalence of COVID-19 and the increasing number of patients indicate the need of the health system to measure the quality indicators of health care. The aim of this study was to determine the level of satisfaction of discharged patients with the diagnosis of COVID-19 from the quality of nursing services in the corona ward.

This cross-sectional study was performed on 110 patients discharged from the corona ward of 22 Bahman Hospital in Khaf over a period of six months. The data collection tool was a questionnaire of patients' satisfaction with the quality of SERVQUAL nursing services, which was conducted by the researcher by telephone from discharged patients. Data were analyzed using SPSS 15 statistical software and one-sample t-test, independent samples t-test and one-way analysis of variance at the significant level of α=0.05.

In the present study, 71 patients (64.5%) were male and 39 patients (35.5%) were female. The highest frequency was related to patients with literacy education (38.2%) and aged 51-60 years (44.5%). Patients' satisfaction with the quality of nursing services in general and its dimensions was moderate (p<0.001).

Since in this study, the satisfaction of COVID-19 patients with nursing services in the corona ward was moderate, it is suggested to managers to plan to motivate nurses in COVID-19 patient care wards. Also, nurses working in the corona ward must be supported in order to encourage them to provide quality care services to eventually increase patient satisfaction with nursing services.

Hypertension is one of the most common problems of the elderly in developing countries, including Iran. One of the main determinants of controlling hypertension is self-care behaviors and one of the factors affecting the level of awareness and thus its more effective control and prevention is health literacy. The aim of this study was to determine the correlation between health literacy and self-care behaviors in the elderly with hypertension admitted to cardiac intensive care units.

The present correlational study was performed in 2020 on 76 elderly patients with hypertension admitted to CCU and post CCU wards in East Guilan public hospitals. The instruments used in this study included a Health Literacy Questionnaire for Iranian Adults (HELIA) and a Self-Care Behavior Questionnaire for patients with hypertension.

The results showed that the majority of elderly people with hypertension had adequate health literacy (57.9%) and relatively desirable self-care behaviors (94.7%). Findings also revealed that there is a significant correlation between health literacy and self-care behaviors (r=0.528 and p<0.05).

Elderly health literacy affects the level of self-care of the elderly, and the higher the health literacy of the elderly, the higher the level of self-care of the elderly with hypertension. So, it can be acknowledged that the issue of health literacy in the elderly is of particular importance and empowering the elderly in the field of health literacy is an important factor in promoting self-care behaviors and ultimately the health of these people. Therefore, it is suggested that health officials and policy makers consider health literacy as one of the most important tools for improving self-care, and also pay special attention to the development, design and implementation of operational plans in this regard.

Sleep disorders in patients in Intensive Care Units (ICUs) are one of the most important causes of increased length of stay, decreased recovery, delirium and neurological and psychological problems. Nursing interventions can be effective in improving sleep disorders. The purpose of this systematic review is to determine the effect of nursing interventions on the improvement of sleep disorders in patients admitted to ICUs.

This systematic review was conducted in the first half of 2021 by searching Persian and English articles in the period from the beginning of 1980 to the first half of 2021. The search strategy and keywords were defined based on the PICO system and inclusion criteria. Search with a combination of Persian keywords: "sleep disorder", "nursing care", "intensive care unit" and their English equivalents sleep disorder, hyper somnolence, insomnia, dyssomnia, sleep apnea, sleep deprivation, intensive care, critical care, ICU, CCU, nursing intervention nursing care in Persian-language databases Scientific Jihad (SID) and information of national publications (Magiran) and English Scopus, Web of Science, Pub Med, Science Direct and Proquest also performed using Google scholar search engine Has been. Qualitative evaluation of articles was performed with Jadad scale. Of the 18,799 initially retrieved studies, 97 reached the final review stage.

The results showed that reducing ambient noise, leisure time protocol, use of ear and eyeglasses, music therapy, aromatherapy and pharmacotherapy, especially oral melatonin, had the greatest effect on the quality and quantity of sleep. Interventions with less impact and application included massage, acupuncture, physiotherapy, milk and honey combination before bed, cognitive-behavioral therapy, spiritual care, follow-up care model, ventilator modes, relaxation and guided visualization. Also, a variety of pharmacological interventions are used as an alternative or in combination with non-pharmacological interventions.

The findings of this study showed that simple and low-cost interventions such as reducing the number of direct care visits, reducing noise and ambient light and using blindfolds and earplugs are the most effective nursing interventions in improving the quality and quantity of sleep in ICUs. After recognizing the cases that cause sleep disorders in patients admitted to ICUs, nurses can prevent the occurrence of complications of sleep disorders in patients with these interventions.

Anxiety caused by Covid-19 causes some psychological problems in nurses. The aim of this study was to determine the relationship between self-perception, resilience and differentiation with anxiety caused by Covid-19 in nurses of Loghman Hakim Hospital in Tehran.

The present study was a cross-sectional study. The statistical population consisted of all nurses in the special ward of Loghman Hakim Hospital in Tehran in the second half of 2020 with 103 people. For this purpose, 81 people were selected as the sample size by simple random sampling. Participants answered questionnaires about "self-concept", Connor's and Davidson's resilience, and anxiety caused by Covid-19 Correlation coefficient and regression were used to analyze the data.

The results showed that between self-perception (r=-0.714, p=-0.001) and resilience (p=0.001, r=-0.862) with anxiety caused by Covid-19, a negative and significant relationship exists between the nurses of the special ward of Loghman Hakim Hospital in Tehran. There is also a positive relationship between differentiation (r=0.667, p=0.001) and Covid-19 anxiety.

The results showed that self-concept, resilience and differentiation are associated with anxiety caused by Covid-19 in nurses.

Unplanned extubation is an important factor in the assessment of nursing care quality. This study aimed to determine the causes of unplanned extubation and its complications in patients admitted to intensive care units in the educational hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences in 2019-2020.

This prospective, cross-sectional multicenter study examined 384 patients admitted to intensive care units by convenience sampling method. The data was acquired through a questionnaire consisting of 3 sections, completed by the nurses working in these departments. The first section of the questionnaire included demographic and medical information of the patient undergoing unplanned extubation. Sections 2 and 3 contained researcher-made checklists about factors regarding extubation, and the subsequent complications, respectively. The validity and reliability of the tool were tested and confirmed by calculating the content validity and test-retest approach. For data analysis, SPSS V22 software was used, along with the descriptive and analytical statistics tests.

In the present study, the incidence rate of unplanned extubation was reported to be 14.06%, the reason for which can be divided into 3 areas including patient-related factors such as delirium, nurse-related factors such as high nursing workload, and factors associated with the department’s design and equipment such as tube cuff rupture. Moreover, most complications due to unplanned extubation in patients included laryngeal hemorrhage and aspiration.

Considering the incidence rate of unplanned extubation in patients admitted to ICU departments in this study was reported to be 14.06%, and the identification of its causes and complications, it is essential to train the ICU staff, especially nurses, to reduce the incidence of this phenomenon.