نشریه پرستاری مراقبت ویژه
سال شانزدهم شماره 1 (پیاپی 57، بهار 1402)

Uremic syndrome, because of chronic renal failure, causes a wide range of problems in patients. One of the most important diseases which can be mentioned is considered to be sleep disorder. The prevalence of sleep disorder has been reported to be 40-85% that can cause a decline in various systems in the body, including cardiovascular and the immune systems and can eventually lead to a decrease in life quality and may also increase the morbidity and mortality rate in these patients. Therefore, finding effective interventions in order to manage sleep disorder of these patients should be part of the comprehensive care plan of patients undergoing maintenance hemodialysis. The present study was conducted to investigate the effectiveness of interventions to improve sleep quality in hemodialysis patients.

A literature search was conducted using PubMed/MEDLINE, Scopus, Web of Science, EMBASE, ProQuest, Science Direct and Cochrane Library databases for publications up to May 2022 in order to find all studies that examined the effects of interventions (pharmacological and non-pharmacological) on sleep outcomes in hemodialysis patients. By performing meta-analysis, Standardized Mean Differences (SMD) and Confidence Intervals (CIs) of 95% were calculated for continuous outcomes using a random-effects model. The heterogeneity among studies was assessed using I2 statistic.

Totally, 15 studies with 997 participants were included in the meta-analysis. Findings reveal a positive effect of interventions on sleep quality based on the Pittsburgh Sleep Quality Index (PSQI) score, (SMD = -1.93, 95% CI = -2.63 to -1.22, P<0.001) with a significant heterogeneity among studies (I2 = 94.9%, P<0.001).

Based on the findings of the present meta-analysis, interventions such as acupressure, relaxation techniques, pharmaceutical interventions and muscle relaxation have a positive effect on the quantity and quality of sleep of patients undergoing hemodialysis. However, due to diversity in methodological quality and the heterogeneity of the studies included in this study, it is difficult to draw definitive conclusions about the effectiveness of different intervention. As a result, the interpretation of the results should be done cautiously.

The outbreak of the COVID-19 crisis has unprecedented pressure to the health systems around the world. Missed nursing care as a care that is needed by the patient but is omitted affects the quality and safety of care. The aim of this study was to investigate the rate and causes of missed nursing care of COVID-19 hospitalized patients in Intensive Care Units (ICUs) of Saqez and Diwandara hospitals.

This cross-sectional descriptive study was conducted in 2021 on 110 nurses working in the special care units for COVID-19. Demographic Characteristics Questionnaire and the Forgotten Care Questionnaires were used to collect information. Data were analyzed using STATA version 12 software and Mann-Whitney, Kruskal-Wallis and Spearman's correlation coefficient tests.

The mean score of missed nursing care in ICUs for Covid-19 was 55.18 (20.24). The most common missed nursing care was controlling the patient's O2 saturation (18.75%) and recording the necessary information of patients (17.86%). The highest percentage of the factors related to missed nursing care was assigned to the lack of nursing staff (86.61%). The most common causes of neglected nursing care were lack of nursing staff (86.61%), lack of assistants or secretaries (74.77%), and the large volume of activities related to the admission and discharge of patients (67.66%).

A high percentage of nursing care in the special care units of Covid-19 is lost under the influence of factors such as the shortage of nursing staff and forced overtime working hours beyond the tolerance of nurses. Nursing managers can create appropriate interventions to support the professional role of nurses during the pandemic by considering related factors.

Considering the widespread psychological effects caused by the spread of COVID-19 in societies, there is strong evidence that the treatment staff of hospitals, due to their jobs, are prone to the occurrence of many psychological disorders, such as reducing self-efficacy, resilience, mental health, and sleep disorders. The aim of this study was to evaluate the effectiveness of cognitive behavioral hypnotherapy on self-efficacy, resilience, mental health and sleep disorders of treatment staff involved in the care of patients with COVID-19.

The research method was quasi-experimental along with a pre-test-post-test design and a control group. The sample consisted of 30 medical staff involved in the care of patients with Covid-19 in Shahid Modares Hospital in Tehran who were randomly divided into experimental and control groups. Cognitive behavioral hypnotherapy sessions were held individually in eight sessions (each lasting for 120 minutes) and one session per week.

Findings show that cognitive behavioral hypnotherapy had an effect on self-efficacy (F=13/15, P<0/001), resilience (F=19/59, P<0/001), mental health (F=25/35, P<0/001) and sleep disorders (F=98/43, P<0/001) in the treatment staff involved in the care of patients with COVID-19.

According to findings it can be concluded that this method can be used to treat disorders of the medical staff in the cases of COVID-19.

Clinical guidelines play a significant role in improving the quality of patient care. Considering the lack of clinical guidelines for the care of central venous catheters in the country, this study aimed to compile a contextualized central venous catheter clinical guideline for being used in Iranian clinical settings.

Contextualizing central venous catheters guideline was based on a developed approached by ADAPTE international collaboration network with three stages of set-up, adaptation and finalization. In the preparation stage, after establishing an organizing committee, the initial search of resources was done to check the feasibility of the study, to identify the required resources and skills and to also write the adaptation proposal. The adaptation phase started with a comprehensive search of resources to retrieve the maximum number of related guidelines. The search of sources led to the retrieval of 410 guidelines, which were reduced to 14 after screening the titles and abstracts based on the purpose of the study and the inclusion criteria. Then, the full text of the 14 included guidelines was reviewed in terms of methodological quality and the result was presented in the expert panel meeting. The methodological quality of the guidelines was evaluated with the AGREEII and a score of more than 70% was considered as an acceptable quality. In this way, one of the guidelines was selected and the adaptation process began. Finally, a translated draft of the guideline recommendations was reviewed in the expert and users panel, respectively. While making the suggested amendments, the level of their agreement with each of the recommendations were reviewed based on Likert scale from 1 to 9 (completely disagree to completely agree). Achieving a consensus more than 80 to assign grades 7 to 9 to each recommendation was resulted in keeping the recommendation. Finally, in the finalization stage, the contextualized version of the selected clinical guide was compiled for being used in Iranian clinical settings.

The full text of the 14 retrieved guidelines were reviewed. Among them, the “Central Venous Access Device (CVAD) Post Insertion Management” clinical practice guideline developed by NSW Agency for Clinical Innovation, with a quality score of 90.4% was selected for adoption. In addition, more than 80% of the stakeholders and expert panel agreed with assigning grades 7 to 9 to all recommendations of this guideline. As a result, all of the 50 recommendations of the guideline in assessment and intervention domains were accepted to be applied in Iranian clinical settings with a few modifications to make recommendations clearer and more understandable for users.

The adopted version of CVAD post-insertion management clinical practice guideline with all 50 recommendations is applicable in caring of Iranian hospitalized adult patients with CVAD.

Dyspnea and respiratory problems are the most common complications of the covid-19 disease. On the other hand, an effective solution to reduce respiratory complications and prevent weakness caused by hospitalization is respiratory rehabilitation. Therefore, this study was conducted in order to determine the effect of breathing exercises on the respiratory symptoms of patients with covid-19.

The present study was a randomized clinical trial study that was conducted on 72 patients with covid-19 after being discharged from the hospital. Patients were randomly assigned into two intervention groups (36 individuals) and a control (36 individuals). The intervention group received a booklet of breathing exercises and training on how to perform diaphragmatic breathing and lip bud breathing through WhatsApp software. For a period of six weeks, telephone follow-up was done twice a week (in the first four weeks) and once a week (in the second two weeks) to perform breathing exercises and to receive a self-reporting checklist of breathing exercises. The control group received routine care and education after discharge. Demographic information questionnaires and the Borg Dyspnea Scale were used to collect data. Two groups completed the data before and after the end of the intervention.

Findings revealed that the mean and standard deviation of the severity of dyspnea before the intervention in the intervention group was 4.61±0.9 and in the control group was 4.14 ± 0.83. After the intervention, it was 2.47±0.56 in the intervention group and 3.67±0.75 in the control group, which shows a decrease in shortness of breath with an average difference of 2.13 between the two groups. Therefore, the effect of breathing exercises on the improvement of respiratory symptoms was statistically significant (P < 0.001). 

Breathing exercises play an important role in improving the rate of dyspnea in discharged patients with covid-19. Therefore, it is recommended to teach breathing exercises before discharge to patients with covid-19.

Empathy is considered as an essential element in nursing care and the essence of all nurse-patient interactions, which can be affected by stressful work environments such as Intensive Care Units (ICUs). High self-esteem enables nurses to establish healthy interpersonal relationships with patients and cope more effectively with stressful situations. This study was conducted with the aim of determining the role of self-esteem and anxiety on the empathy of nurses working in ICUs.

This study is a cross-sectional research. The research population included nurses working in the adult inpatient wards of hospitals affiliated to Ilam University of Medical Sciences in 2023. Accordingly, 217 nurses were selected using the Karjisi and Morgan table in a convenience manner. Data were collected using the Demographic information questionnaire, Spielberger's anxiety, Rosenberg's Self-esteem Questionnaire, and Jefferson's Empathy questionnaire. The collected data were analysed using descriptive and inferential statistics.

The mean empathy, anxiety, and self-esteem of nurses were 92.38 ± 15.17, 65.66 ± 20.64, and 20.46 ± 5.49, respectively. A positive and significant relationship was observed between empathy and self-esteem (P < 0.01), and a negative and significant relationship was observed between empathy and anxiety, as well as self-esteem and anxiety (P < 0.01). The results of the Bootstrap and Sobel test showed that self-esteem plays a role in the relationship between empathy and anxiety in nurses working in ICUs. Actually, the higher the self-esteem of nurses, the less anxiety they experience and the more empathy they show in caring for special ward patients.

According to the findings of the present study, it can be stated that a significant relationship exists between self-esteem, anxiety and empathy. In addition, self-esteem plays a role in the relationship between empathy and anxiety. Therefore, it is necessary to develop and use programs that increase self-esteem in order to manage anxiety and strengthen empathy skills in the stressful conditions of the ICU.

Hospitalization in the Intensive Care Unit (ICU) is associated with side effects such as anxiety, pain and fear of an unknown environment and causes hemodynamic instabilities (increased blood pressure, pulse and breathing rates, etc.) These hemodynamic instabilities lead to the use of sensory stimulation programs which can be prevented, however knowing and using the best sensory stimulation program is of particular importance. The current study was carried out with aim of comparing the effect of auditory stimulation and tactile on the physiologic parameters in patients with Level of Consciousness hospitalized in the ICU in ‎Ali-Ebne-Abitaleb Hospital in Zahedan in 2021.

In this single-blind semi experimental study, at first 80 patients in the ICU in Ali-Ebne-Abitaleb Hospital who met the inclusion criteria were selected and then randomly allocated by permutation block into two groups of auditory stimulation and tactile. In the auditory stimulation group, a prepared auditory file was used for 15 minutes for three days. In the tactile group, touching the hands patients was done for 15 minutes for three days. Physiologic parameters such as heart rate, respiratory rate, systolic and diastolic pressure, mean arterial pressure and O2 saturation was measured and recorded 5 minutes before and after the intervention by Cardio Set LX110 monitoring.

Findings revealed that the mean of systolic pressure and O2 saturation was not significantly different after the intervention between the two groups (p > 0.05). However, in terms of the variables such as heart rate, respiratory rate, diastolic and mean artery pressure, the independent- T- test showed a significant difference after the intervention between the two groups (p < 0.05).

The application of the two stimulation methos can adjust some physiologic parameters in patients in ICUs. Furthermore, these methods can be used as simple, cost-effective and applicable methods for managing pain and recovering the physiologic parameters.