نشریه پرستاری مراقبت ویژه
سال پانزدهم شماره 4 (پیاپی 56، زمستان 1401)

Occupational stress reduces the efficiency, productivity and quality of work and affects the body, mind, behavior and job performance of a person. Having time management skills helps to prevent and control the consequences of occupational stress. This study aimed to determine the relationship between time management and occupational stress of critical care nurses.

This is a cross sectional study that was conducted on 350 nurses working in adult critical care units (CCU and ICU) of teaching hospitals in Tehran, 2022. Nurses were selected by multistage cluster sampling. The research data collection tool included the Condensed Nurses' Occupational Stress Scale (NOSS) and time management questionnaire.

In this study, 55.7% of nurses were women, and bachelor's education was the most frequent with 75.7%. In addition, 38% were between 30 and 39 years old and 58% were married. Time management of 45.4% of nurses was at a favorable level and 9.4% was at a very favorable level. None of the nurses had unfavorable time management. The mean and standard deviation of time management (based on 0 to 100) of nurses was 56.41 ± 19.67. The mean and standard deviation of occupational stress of nurses was 51.39 ± 10.77. Time management and its dimensions had a statistically significant negative correlation with occupational stress and its dimensions, that is, with increasing time management, occupational stress decreases (r = 0.638, p<001). The results of linear regression analysis showed that time management (adjustment of responsibilities and norms, management of requests and management of emotions) can explain 51% of nurses' occupational stress (p<0.05)

According to findings, the majority of nurses had good time management, and with increasing time management, job stress decreased.

Nursing is a care profession and nurses, due to their professional nature, need moral courage to provide safe and professional care to clients. On the other hand, one of the needs of nursing education is to improve the professional ethics skills of nurses in order to provide nursing care based on professional standards and ultimately to ensure proper clinical care. Therefore, this study was conducted to investigate the relationship between clinical competence and moral courage of nurses working in the intensive care units' hospitals of Tehran University of Medical Sciences at 2020.

This multicenter Cross-sectional Study was conducted on 350 nurses working in the intensive care units' hospitals of Tehran hospitals who were selected by quota method. The data collection tools of the study included demographic questionnaire, clinical competency questionnaire of intensive care unit nurses and moral courage questionnaire of Sekerka et al.

The mean scores of total moral courage and clinical competence in intensive care unit nurses were 74.24±12.22 and 155.10±23.37, respectively. There is a strong and significant direct relationship between moral courage and clinical competence of nurses (r=0.81 and p=0.001). Clinical competence in nurses with more work experience, older, working in the morning and day shifts and with formal and contract employment status was significantly higher than other nurses (p<0.001). Also, moral courage in male nurses, married, with more work experience, older, working in the morning and day shifts and with formal and contract employment status was significantly higher than other nurses (p<0.001).

According to the results of the present study, moral courage increases with increasing the clinical competence of nurses. Therefore, it requires the attention of as many officials as possible in this regard.

The ability of nurses in cultural understanding in order to provide care in harmony with the patient's culture is a symbol of nurses' cultural competence. This study was conducted with the aim of determining the cultural competence of nurses working in Intensive Care Units (ICUs) and its relationship with demographic factors.

This cross-sectional study was conducted in 2019 on 160 nurses working in ICUs and Coronary Care Unit (CCU) of two centers; 5- Azar and Shahid Sayad Shirazi, as referral centers for patients across the province and affiliated to Golestan University of Medical Sciences. For data collection, convenience sampling method was used based on the inclusion criteria. The data collection instrument was a demographic form and a cultural competence questionnaire (51 items and 4 subscales). The reliability of the present study was 0.94. After obtaining an informed consent from the nurses, the questionnaires were completed. Data analysis in spss16 with descriptive statistics; frequency, average and standard deviation, as well as after determining normality with the Shapiro-Wilk test, with inferential statistics; multiple and univariate regression were performed. The significance level was 0.05.

Most of the nurses in ICU (59.1%, 75 people) and CCU (57.6%, 19 people) were male. The minimum age of research samples in both ICUs and CCUs was 23 years. The highest average score of cultural competency in both wards was related to the attitude towards cultural care (0.54±0.22), (0.56±23) and the lowest  score was cultural care knowledge (0.48±0.23) (0.44±0.22). The level of cultural competency in both ICUs and CCUs was reported to be weak (82.7%, 81.8%). Totally, the average score of cultural competency in the ICU was higher than the CCU, but there was no statistically significant difference. Also, none of the independent variables alone or in the presence of the other variables had  a significant effect on cultural competence.

Considering the weak view of nurses towards cultural competency and regarding the fact that cultural care attitude had the highest average and cultural care knowledge had the lowest average, cultural competency training seems necessary to provide the highest level of care in CCUs. In this way, health system policy makers and nursing managers can move the cultural competency from cultural attitude to the preparation and implementation of cultural care by conducting educational workshops about culture and communication.

Patients undergoing hemodialysis have various digestive problems such as constipation, which affects their quality of life. This study was conducted with the aim of determining the relationship between the severity of constipation and the quality of life of hemodialysis patients in Chaharmahal and Bakhtiari province.

This cross-sectional study was conducted on 200 hemodialysis patients as a census in four teaching hospitals affiliated to Shahrekord University of Medical Sciences in 2021. The research tools included the demographic and clinical characteristics form and laboratory variables, the Patient Assessment of Constipation Quality of Life (PAC-QOL) and the Constipation Assessment Scale (CAS).

The mean total quality of life of the patients was 38.93±31.213. The relationship between the four subscales of quality of life and the severity of constipation revealed that there is a statistically significant correlation between the quality of life and its subscales with the severity of constipation (p<0.001). There was also a statistically significant relationship between the quality of life and the variable of education and employment status (p<0.001). In addition, there was a statistically significant relationship between the subscale of concern and worry with weight (p=0.028) and between the subscale of satisfaction with hematocrit (p=0.043).

Based on the results of the present study, there is a significant relationship between the quality of life and the severity of constipation and the variables of education and employment status. Also, a significant relationship was observed between the subscale of concern and worry with weight and between the subscales of satisfaction with hematocrit.

The family is one of the most important social institutions, and based on the principles of palliative care, the families of patients admitted to Intensive Care Units (ICUs) are considered clients. Paying attention to their needs is essential and in line with holistic nursing care. Therefore, this study was conducted with the aim of determining critical care family needs of patients hospitalized in ICUs.

The present study is a cross-sectional study. The target population was all the family members of the patients admitted to the ICUs of the teaching hospitals affiliated to Kermanshah University of Medical Sciences in the first half of 2022, who were included in the study using non-random quota sampling. In order to collect data, the demographic profile form of participants and the clinical profile of patients and the Critical Care Family Needs Inventory (CCFNI) were used. SPSS version 19 statistical software and independent t-tests, one-way analysis of variance and Pearson's correlation coefficient were used to analyze the data. Also, a significance level of less than 0.05 was considered.

The average age of the participants in the study was 42.4 years (minimum age 19 and maximum 78 years). Also, 52.7% of the family members of the patients hospitalized in the ICUs were male and 47.3% were female. About 31.9% had university education, 34.8% had diploma education and 33.3% had sub-diploma education. Also, 74.9% of people were married and 66.2% had children. The mean score of critical care family needs was 143.3 ± 17.2 (3.18 from the range between 1 and 4). The most important subscales of the care need of family members of patients hospitalized in ICUs were the need for assurance, comfort, information, proximity, and support.

The level of critical care family needs was in high range. Also, the level of need for support was the lowest and the level of need for assurance was the highest. Due to the fact that assessing and providing the needs of family members is in line with holistic nursing, therefore, the feeling of high care needs of these people indicates the greater importance of nurses in this matter, especially because patients hospitalized in the special care department have special and more acute conditions. While providing accurate nursing care for patients, they should also try to meet the care needs of their families.

Diagnosing the level of anxiety of patients before surgery can reduce many challenges during and after the operation. Therefore it is necessary to use tools that have high accuracy in diagnosing the level of anxiety. The present study was designed with the aim of comparing the accuracy of two instruments of cortisol level and anxiety measurement questionnaire in diagnosing the level of preoperative anxiety in patients who were candidates for thyroidectomy surgery.

The current clinical trial study was designed to compare the accuracy of two preoperative anxiety measurement tools in thyroidectomy patients in 2019. The selection of samples was done by available sampling method with random allocation through blocks of four. In the test group, awareness was given through peers, and in the control group, routine care was provided. Before and after the intervention, Spielberger questionnaire was completed and salivary cortisol measurement was done for 78 people (39 people in the test group and 39 people in the control group) by patients admitted to Valiasr General Surgery Department and Cancer Institute of Imam Khomeini Hospital in Tehran.

The independent t-test showed that the amount of salivary cortisol after the intervention in the test group was significantly lower than the control group (p<0.001), while the Spielberger questionnaire did not show a significant difference between the anxiety scores of the two groups after the intervention (p=0.397)

Since cortisol is not affected by situational factors, it is a more accurate tool than the questionnaire to measure anxiety. However, it is recommended to use a combination of physiological and chemical tools in order to measure the level of anxiety.

Intensive Care Units (ICUs) are considered one of the most complex hospital units due to their high sensitivity. Therefore, nurses face challenges such as uncertainty that can affect nursing performance. The present study was conducted with the aim of investigating the relationship between resilience and uncertainty and intolerance of uncertainty among nurses working in ICUs.

The present study was a cross-sectional study. By using the stratified random sampling method, 237 nurses working in adult ICUs in hospitals affiliated to the Tehran University of Medical Sciences were selected in 2022. Data were collected through demographic information questionnaires, uncertainty questionnaire and uncertainty intolerance questionnaire. Data analysis was done using descriptive and inferential statistics at a significance level of less than 0.05.

The mean resilience score of nurses participating in the study was 20.4 with a standard deviation of 2.6. Furthermore, 75% of nurses achieved the average level of resilience. There was a significant positive correlation between resilience scores and intolerance of uncertainty in nurses (p<0.001, r=0.213) and a significant but weak positive correlation between resilience and uncertainty scores in nurses (p=0.004, r=0.188). So that with the increase of nurses' resilience scores, their uncertainty score generally increased.

The findings revealed that uncertainty and its intolerance have an inverse relationship with resilience, and this shows that uncertainty and its intolerance are complex concepts and components that can be affected by several factors that require further study in this area. On the other hand, resilience cannot be the solution to all the problems of nurses in clinical environments. As the findings in this study showed, increasing resilience has not been able to reduce uncertainty and intolerance, and this finding can be the beginning of other studies to identify predictors of uncertainty and intolerance.

The covid-19 pandemic has caused post-traumatic stress symptoms and a decrease in psychological capital in people. To solve these problems, interventions such as emotion management are needed. This research was conducted with the aim of determining the effectiveness of emotional management training on post-traumatic stress symptoms and psychological capital of those who have recovered from Covid-19.

The research method was semi-experimental with a pre-test-post-test design along with a control group. The statistical population included those who recovered from Covid-19 in Bandar Abbas city in 2019. Among them, 27 people who recovered from Covid-19 were selected and replaced randomly by lottery in two experimental and control groups (13 people in the experimental group and 14 people in the control group). The people in the experimental group received emotional management training (10 sessions) and one session every week. The questionnaires used in this research included post-traumatic stress symptoms and psychological capital.

The results showed that before the intervention, there was no significant difference between the average scores of post-traumatic stress symptoms and the reduction of psychological capital in the intervention and control groups, but there was a statistically significant difference between the average scores in the intervention and control groups after the intervention. The mean and standard deviation of post-traumatic stress symptoms in the post-test was 41.46 ± 8.55 and psychological capital was 64.07 ± 9.86 (p<0.001).

According to the results of this research, emotion management training reduced post-traumatic stress symptoms and increased psychological capital in those who recovered from Covid-19. Since the favorable mental state of the patient has an effect on his recovery, the use of this method is recommended as an effective strategy to reduce the psychological problems of patients.