نشریه پرستاری مراقبت ویژه
سال چهارم شماره 4 (پیاپی 13، زمستان 1390)

Purposes of the study: Moral distress elicits some responses from nurses. Identifying these responses can lead into developing effective strategies which assist nurses with facing them. The present study tries to elicit responses of ICU nurses to moral distress. This is a qualitative research with an analytical approach. The required data was gathered through deep and unstructural interviews (retrospective interviews). 13 individual interviews and two group interviews were conducted with clinical nurses working in ICUs of different cities in Iran. Samples were taken purposefully and data analysis was carried out by analyzing the qualitative content. A nalyzing the content, 3 central themes, 5 subthemes, and 28 categories were obtained. The main themes included "psychosomatic reactions", "spiritual reactions", and "coping methods” of nurses in response to moral distress in ICUs. the obtained results of this study asserted that facing moral distress, ICU nurses produce various reactions and adopt alternative coping methods, some of which are positive and some are not. Applying positive coping methods and preventing harmful outcomes, nursing administrators can help ICU nurses to reduce moral distress.

Evidence-based clinical guidelines effectively guide medical teams and nurses to increase the quality of clinical work. Designing evidence-based guidelines in critical care units, especially in cardiac care unit is much more needed. Therefore, this study was conducted to design evidence-based nursing care guidelines for patients with angina pectoris. This descriptive-comparative study was conducted in two cardiac care units in Baqiyatallah Hospital in Tehran in 1390. First, the quality of 30 available care guidelines was investigated via a checklist designed by the researcher in three levels: good, average and poor. Then nursing care guidelines were designed based on Stetler model with an evidence-based approach and their quality was re-investigated. Finally, the collected data was analyzed by the help of descriptive statistics and using SPSS 17 software. Quality of 26.7 % of the available guidelines was found out to be poor and 73.3 % was proven to be average. After designing the guidelines, this number increased to 100 %. Finally, an eight evidence-based nursing care guideline was designed for patients with angina pectoris. Since the available guidelines are of low quality, designing evidence-based care guidelines can improve nursing care.

Improper positioning and excessive immobility has serious side effects on patients after angiography. The present study tries to determine the effects of position change and bed-rest duration on vascular complications after angiography.

In a random clinical trial, 130 patients, who had undergone a coronary angiography via the femoral artery, were randomly assigned into a test and a control group (each group consisting 65 participants). The patients in the test group experienced position changes in four hours. For two hours, they rested with a sand bag in their bed. In the fourth hour, they were allowed to leave the bed. The patients in the control group received routine treatment. Vascular complications were investigated in both groups at regular intervals. The required samples were randomly taken from among patients of “Research and Education Center of Rasht” in two months, in 1389. The collected data was analyzed by applying descriptive and inferential statistics and also SPSS16 software.

In the test group, bleeding occurred in one of the patients in the fourth hour. It also happened for one of the patients of the control group immediately after coming to ward (p<0315). In the second hour, in the test group, hematoma occurred in one of the patients. It was also observed in one of the patients of the control group during the first and the second hour (p<0.315). In the fourth hour, two cases of hematoma were observed among the patients of the control group (p<0.154). The Fisher’s exact test proved no significant difference between the two groups.

In accordance with the findings of this study, position change and early ambulation after angiography do not increase the risk of vascular complications, can bring patients some comfort, and result in their earlier discharge from hospitals.

Despite advances made in hemodialysis patients, especially in recent decades, adequacy of dialysis is less than the normal amount of the 1/2- 1/9 is. This study aimed to determine the effect of exercise Hathayoga adequacy in hemodialysis patients has been designed and implemented. The present study, the two groups are controlled in 31hemodialysis patients from shahid Labbafinejad hospital in the control group and 31 hemodialysis patients from the baqiatallah hospital participated in the test group and a modified Hatha Yoga exercises after initial training by yoga instructor, for one hour twice a week and two months in the group were. Adequacy of dialysis by Daugirdas II Formula before and after intervention Both groups were calculated with the help of statistical tests were analyzed The results showed that adequacy of dialysis patients has increased significantly (p <0 / 001). Average kt / v before and after the intervention groups, respectively, 0/ 96 ±0 / 23 and 1 / 14 ± 0/ 22 (p <0 / 001) and the average score of kt / v in the control group, respectively1 / 3± 0 / 26 and 1/ 31 ± 0.2 5 (p = 0.09). Considering the significant increase of dialysis adequacy Hahta Yoga exercises recommended to teach simple skills such as this group of patients is.

Drug interaction occurs when a drug affects the action of another. In this line, the present study has been conducted to determine the prevalence of potential drug interactions in critical care units.

In the present retrospective study, the first twenty-four hour prescriptions of 371 patients admitted to intensive care unit of Shahid Bahonar hospital of Kerman were investigated in terms of the number and type of drug interaction in addition to other factors such as number of drugs, age, gender, length of ICU stay and number of prescribing doctors. In order to determine the number and type of drug interactions, a reference textbook of "Drug Interaction Facts" was used, and data analysis was performed by SPSS18 statistical software with respect to the study objectives using descriptive statistics, Pierson correlation test, independent t-test, and variance analysis.

In terms of the drugs received, 77 different drugs and, in total, 2091 cases of drug prescription were found with the average of 5.6 (±1.5) for each patient. Overall, 726 cases of drug interactions were observed among critical care unit patients in the first 24 hour of prescription. Delayed, moderate, and possible interactions were accounted for the most interactions found. The results are indicative of a significant correlation between the number of drug interactions and prescribed medications, age, gender, duration of hospitalizations and number of prescribing doctors.

Due to possessing more risk factors of drug interactions, critical care unit patients are at higher risk of developing drug interaction which behooves the medical team to pay more attention to this issue.

Depression and anxiety are the factors that increase death risk in the patients with heart disease. This study was done with the purpose of studying depression and anxiety rates in the patients with acute coronary artery disease. This cross-sectional study which is descriptive was conducted on 366patients in the CCU of heart and cardiology wards of Kerman University affiliated hospitals 48hours and 6days after admission in 2010. A questionnaire was used for gathering information on hospital anxiety and depression. The data was analyzed using T- test and variance analysis and SPSS17 software. The mean score of anxiety was 10.12 ±3.49 and the mean score of depression was 10.10 ±2.69 after 48 hours of admission. After 6 days of admission, the mean score of anxiety was 10.17± 2.97 and the mean score of depression was 9.95±2.62. There was no meaningful discrepancy between the depression and anxiety scores in 48 hours and 6 days after the admission. Due to high amounts of depression and anxiety in patients with coronary artery disease and their remarkable impact on disease consequence, effective measures are needed in quick recognition and decreasing their impacts.

patients who take self-care responsibility have been reported to be in less or no need of drug interventions. In this line, the present study was implemented to determine the self-care ability among patients with heart failure.

The present descriptive cross-sectional study has been carried out on 72 patients with heart failure and at least 18 years of age admitted to Imam Khomeini hospital of Ardebil within the time interval of late May to late July, 2010. Data were collected by the European questionnaire of self-care behaviors and were analyzed by SPSS 17 statistical software and descriptive-statistical tests.

Self-care ability with the average of 41.18 (±6.26) was found to be in a moderate level. Statistical analysis showed significant relationship between heart failure, age, marital status, education, history of training, monthly income, development of other chronic disorders and profession with self-care agency (p<0.05), and no significant correlation has been found between the place of residence and gender with self-care ability (p> 0.05).

The results indicated moderate self-care ability among the study participants which is affected by basic influential factors including the level of patient's health. Therefore, nurses are required to identify help-seeker's need while performing nursing interventions and investigating self-care behaviors and design and implement planned training to promote self-care ability among patients.

Identification of priorities in intensive care units is a matter of high complexity due to dysfunction in patient's vital organs such as blood, lung and kidney which often undergo rapid changes in the mentioned wards. Nurses should therefore be able to make decisions with respect to priorities to resolve this problem. In this regard, the present study was undertaken to investigate the efficacy of APACHE II instrument. In the present study in 2010, 70 patients of intensive care units with congestive heart failure and chronic obstructive pulmonary disease were evaluated, for whom the APACHE II scores were calculated. The research was conducted in a cross-sectional approach, in which patient's death or survival was recorded. SPSS15 statistical software was applied for statistical analysis, and clinical parameters were investigated using descriptive-statistical tests. The study findings showed significant difference between survivors and non-survivors with respectively 3.5 (±13.6) and 17 (±2.5) as the mean (±SD) APACHE II scores. Fifteen percent mortality rate was observed in patients with scores under 15, while it was 36% in those with scores ranging from 16 to 19, and almost 100% in participants obtaining 20 to 30 scores. The APACHE II scoring system has been successful in predicting the mortality rate in intensive care unit patients and it has been found to be higher than the standard level in all patients.