نشریه پرستاری مراقبت ویژه
سال شانزدهم شماره 2 (پیاپی 58، تابستان 1402)

Chronic Obstructive Pulmonary Disease (COPD) is one of the most common respiratory diseases. Due to limitation of breathing; especially on exhalation, shortness of breath, mostly on exertion is the main complaint of these patients, which in turn leads to a decrease in functional capacity and physical activity during daily life activities. Breathing exercises, pulmonary rehabilitation along with drug therapy, are foundation treatments. However, one of the obstacles of rehabilitation programs is the discrepancy between therapeutic measures and social-cultural aspects of patients’ personal lives that decrease the success rate of programs in long term. The aim of the present study was to investigate the effect of reciting the Quran by tartil as a culture- based breathing exercise on functional capacity of patients with COPD.

The study was a prospective case series study done on a group of COPD patients referring to an outpatient respiratory clinic. They were enrolled in the study voluntarily with consideration of ethical codes. They were stable but had imitation in daily activities due to exertional dyspnea. The study was commenced on 2021/04/14 and terminated after six weeks. The subjects recited as much as Ayat of Yassin every day by tartil. Forced Expiratory lung Volume in first second (FEV1) and 6-minute walk distance test were measured before and after the study.

In order to carry out this study, eight COPD patients participated. The mean age was 66.38 ± 12.00 years, ranging from 42 to 83. Participants included three women and five men. Mean FEV1 increased at the end of study from 1.58 ± 0.76 to 1.36 ± 0.46. (P value = 0.002). The distance on six-minute walk distance test (6 MWT) increased from 310.60 ± 71.43 meters to 356.25 ± 85.72 meters significantly (P value = 0.002). The subjects perceived their shortness of breath decreased during 6 MWT at the end of study. The score decreased from 5.5 ± 1.5 to 4.5 ± 1.5 (P value=0.007).

Our preliminary results showed that reciting the Quran by tartil, which is compatible with religious culture, can increase the functional capacity of COPD patients. In reciting, the expiratory time and flow are adjusted to produce Quranic sounds. This might in turn reduce lung hyperinflation and air trapping. These changes cause an increase in the functional capacity of patients in terms of six-minute walk distance. In addition, a higher motivation of patients to perform such practical and functional exercises guaranties efficiency of such pulmonary rehabilitation in long term.

Intensive Care Units (ICUs) are considered as one of the most complex hospital units due to their high sensitivity and special conditions. Therefore, nurses in special care departments experience many challenges such as moral injury and conflict with management elements that can affect their performance and health. Moral injury is defined as guilt, social isolation and emotional numbness, which can affect the performance and physical and mental health of nurses. Therefore, the present study was conducted with the aim of investigating the relationship between moral injury in nurses and the ethical climate of critical care units.

The present study was a cross sectional research that was conducted in 2022 in the ICU and Critical Care Unit (CCU) departments of hospitals affiliated to Tabriz University of Medical Sciences. The study population included 266 nurses working in CCUs who were selected by simple random method. Research tools included demographic questionnaire, moral injury questionnaire and ethical climate.

According to the findings of the present study, the average score of the ethical climate of special care units in general was 77.31 ± 6.84 and the average score of moral injury among nurses was 40.67 ± 3.93, which indicates the favorable ethical climate of ICUs and severe moral injury in nurses working in these departments. Among the different dimensions of Ethical climate, the highest score was related to the instrumental dimension with an average of 22.65 ± 3.57 and the lowest score was related to the independent dimension with an average of9.11 ± 2.13. By using the Pearson's correlation coefficient, no significant relationship was observed between ethical climate and moral injury. However, moral injury had a significant and inverse relationship with the organization's ethical climate rules and regulations subscale (P = 0.24, r = -1.38) and had no statistically significant relationship with the other ethical climate subscales (P>0.05).

The findings showed that there is no significant relationship between the moral injury of nurses and the ethical climate of CCUs. Therefore, moral injury in nurses includes complex components and concepts that can be influenced by several factors. Also, the findings showed that the increase in organizational rules and regulations in CCUs will reduce the moral injury in nurses working in CCUs, so managers and trustees of medical systems should pay attention to this issue and take measures. Practices can reduce moral injury and also increase health and job satisfaction in nurses.

Compliance with airway care standards is necessary to maintain the health of patients admitted to special departments of hospitals. The aim of this study was to determine the relationship between compliance with airway care standards and complications from endotracheal intubation.

This descriptive-analytical research was cross-sectional. The research population of this study consisted of 122 nursing personnel working in four hospitals and in the internal ICU and surgical ICU departments of Persian Gulf Bushehr Hospitals, cardiac surgical ICU of Bushehr Heart Hospital, Salman Farsi Bushehr and internal and surgical ICU of Waliasr (AS) Hospital in Kazeroon, who were selected as a whole. In addition, 152 patients hospitalized in these departments were also included in the study for care evaluation. The data collection tool, including personnel demographic information and tracheal tube care checklist (including 69 questions and three items) was taken from the set of nursing care guidelines of the nursing system organization, and its validity and reliability were measured in this study.

The average age of the participants was 33.06 ± 55.3 years. Most of the nurses were women (62 people) and were working in the internal ICU department (63 people). Most of the participants had a bachelor's degree (113 people), and their work experience was 2-5 years (59 people). None of the variables of gender, education, work history, retraining history, and job status of nurses had a significant relationship with the degree of compliance with nursing care standards (P < 0.05). There was a significant relationship between the service location variable and the level of compliance with nursing care standards (P = 0.006(. Among the patients under care, 25.4% of ventilator-associated pneumonia complications, 22.4% of pressure ulcer complications, and 18.4% of extubation complications were reported. Also, there is a significant difference between the level of adherence to airway care standards and the complications caused by endotracheal intubation in patients (P -value<0.05).

The results of this study indicate that the level of adherence to airway care standards by nurses is related to factors such as the service department. Also, the level of adherence to airway care standards is related to complications caused by endotracheal intubation in patients.

During the covid-19 pandemic, the need for health care services increased dramatically. In this situation, the care delivery time is extremely important. About three to five percent of covid-19 patients need intensive care. Organizational commitment is one of the most important predictors of the quality of care. This study was conducted with the aim of determining the organizational commitment of nurses working in Intensive Care Units (ICUs) during the covid-19.

This cross-sectional descriptive study was conducted during 2022 in Baqiyatallah Hospital. Allen and Mayer's (including affective, normative and continuous domains) and Balfour and Wechsler (including attachment, exchange and identification domains) organizational commitment questionnaires were used. Using the random sampling method, totally 210 nurses who were working in inte ICUs were asked to fill the questionairs.

The mean scores for Allen and Mayer and Balfour questionares were 67.87 ± 13.04 and 25.95 ± 4.05, repectively. There was a significant correlation between the scores of Allen and Mayer and Balfour (r = 0.65, P = 0.00). In addition, the multivariate linear regression analysis showed non- significant correlation between the scores of Allen and Mayer and Balfour questionares.

Considering that better and more comprehensive care needs higher organizational commitment, it is necessary for nursing managers to pay special attention to the organizational commitment for increasing the quality of care.

Several issues cause agitation in patients hospitalized in the Intensive Care Unit (ICU), which in turn causes many complications in patients. For this reason, various methods have been used to reduce agitation, each of which have advantages and problems. The purpose of this study was to investigate the effect of the care plan based on the Roy adaptation model on the level of agitation in patients of the ICUs.

This triple-blind clinical trial study was conducted in 2015 on 100 patients in a ICU. Two ICU wards in Sanandaj Besat Hospital were randomly selected as intervention and control wards, and eligible patients in each ward were assigned to the intervention or control group separately by a simple random method. In the intervention group, care based on Roy adaptation model was performed and in the control group, routine care was performed. The data were collected using Richmond agitation scales.

The average agitation at different times did not show a significant difference between the control and intervention groups (P>0.05).

Care based on the Roy adaptation model by nurses did not affect the agitation of ICU patients. It is suggested to provide organized nursing care based on other nursing models in order to improve the health of patients in the ICUs.

Chronic diseases challenge the cognitive and behavioral systems of patients. The purpose of the present study was to compare the effectiveness of group training of coping skills and mindfulness on pain perception and cognitive flexibility in patients with kidney failure with a lasting effect.

This semi-experimental study was carried out cross-sectionally. The statistical population of this study included all kidney failure patients who were referred to Shariati Hospital in 2021-2022 (from February to June). Accordingly, 45 patients with kidney failure were selected voluntarily and were randomly assigned to two experimental groups and one control group by using matching method. All the three groups responded to the McGill Pain Questionnaire (1997) and the Cognitive Flexibility Questionnaire (2010) in the pre-test, post-test and follow-up stages. The group therapy program based on mindfulness on the first experimental group and coping skills on the second experimental group were implemented in eight sessions, each lasting for one hour and a half.

The findings indicated that group training of coping skills and mindfulness leads to a reduction in pain perception and an increase in cognitive flexibility. Therefore; There is no significant difference between the effectiveness of group training of coping skills and mindfulness on pain perception and cognitive flexibility in patients with kidney failure (P = 0.001).

Two types of grouping training interventions, coping skills and mindfulness; can affect pain perception and cognitive flexibility in patients with kidney failure, and this effectiveness continue

Due to the increase of chronic and incurable patients, the need for palliative care in nursing is essential. Nurses need to acquire special knowledge and skills to provide quality palliative care. The aim of this study was to investigate the relationship between palliative care knowledge and the level of anxiety, stress and depression of special care nurses in hospitals affiliated to Rafsanjan University of Medical Sciences in 1400.

This cross-sectional descriptive study was conducted with the participation of 77 nurses working in the Intensive Care Unit (ICU) of Ali Ibn Abi Talib (AS) Rafsanjan Hospital in 1400. The level of knowledge of nurses was measured using the PCNQ questionnaire and the level of anxiety and depression was measured using the DASS-21 questionnaire.s 33.34 ± 5.17; The majority of them were women (62 people, 80.88%), single (53 people, 68.78%) and with work experience of more than ten years (36 people, 46.66%). The knowledge of nurses was checked through the PCQN questionnaire, which includes 20 questions with yes or no answers, and the participant receives a score of one for a correct answer and a score of zero for a wrong answer. The range of scores of the questionnaire is from a minimum of zero to a maximum of twenty, and a score of 15 and above indicates sufficient knowledge in the field of palliative care. The questions of this questionnaire include: principles and philosophy dimension, pain management dimension and palliative care spiritual services dimension. The average score was 2.65 ± 0.40 in principles and philosophy, 3.37 ± 13.89 in pain management, and 1.86 ± 0.97 in spiritual services. The total mean score of nurses' knowledge of palliative care was 2.7 ± 0.72. Moderate to very severe anxiety, stress and depression were seen in all nurses of the ICU. So that 48.1% had moderate depression, 31.2% had very severe stress and 50.6% had very severe anxiety. According to the results of the correlation analysis, no significant correlation was observed between the overall PCQN score and anxiety, stress and depression.

The palliative care knowledge of special care nurses is insufficient, therefore, in order to fill this knowledge gap, it is suggested to develop comprehensive training programs for bedside nurses and provide palliative care topics in nursing undergraduate courses. In addition, the level of anxiety, stress and depression of nurses in special care departments is relatively high. Accordingly, no significant relationship was observed between palliative care knowledge and anxiety, stress and depression.

Anxiety in patients under Coronary Angiography leads to changes in cardiopulmonary parameters. The current study aimed to compare the effect of virtual reality and rhythmic breathing on the physiological parameters of patients undergoing coronary angiography.

In this clinical trial, 90 patients admitted to the cardiac care ward were studied in 2019-2020. They were selected by convenience sampling and randomly allocated into three groups: virtual reality, rhythmic breathing and control. Virtual reality and rhythmic breathing groups received intervention and the control group received routine care. Systolic and diastolic blood pressure, heart rate; respiration rate and arterial oxygen saturation were measured before, half an hour and one hour after the intervention in three groups.

Findings revealed that the pattern of changes of the mean of respiration and heart rate was significantly different in all the three stages of measures in the three groups (P˂0.001). In the case of systolic and diastolic blood pressure and arterial oxygen saturation, the pattern of changes did not show a significant difference in the three groups (P>0.05).

The use of these methods can lead to modification of some physiological parameters. This means nurses can use these methods as non-invasive, without side effects, cheap and applicable methods in order to improve patients’ physiological parameters.