نشریه پرستاری مراقبت ویژه
سال هشتم شماره 2 (پیاپی 27، تابستان 1394)

a standard tool is required to investigate and determine of family satisfaction level of adult patients hospitalized in Intensive Care Units (ICUs). Since such tools haven''t been localized in Iran so far، the aim of this study was translation and validation of family satisfaction questionnaire (FS ICU-34) of adult patients hospitalized in ICUs in Iran. This is a methodological study. Face and content validity process was carried out after translating English version of the tools through forward-backward translation technique، confirmed by WHO (World Health Organization)، and exploratory factor analysis was conducted by investigating three hundred questionnaires completed by family members of adult patients hospitalized in ICUs of Tehran hospitals in order to investigate construct validity. in exploratory factor analysis، three subscales including: satisfaction with medical staff performance (12 items)، comfort (12 items) and decisionmaking (6 items) were determined by Eigen value above one and factor load above 0. 5. Cronbach''s alpha in the first، the second and the third subscale were respectively achieved; 0. 93، 0. 92 and 0. 84 and Cronbach''s alpha of the tools was achieved 0. 95. In this study the number of the questions was decreased to thirty. after performing procedures of determining validity، necessary changes in the number of the questions، writing and number of the questionnaire areas were carried out and it became clear that the Persian version of the questionnaire FS-ICU 34 benefits high reliability (α= 0. 95). Removingsome questions due to their low scores allocated by Experts’panel was done during the stages of determining validity and it was done among Iranian respondents due to cultural incompatibility. Content validity index of all the satisfaction Persian tools of family members of adult patients hospitalized in ICUs through two S-CVI/Ave and S-CVI/Universal validity methods were respectively achieved 0. 97 and 0. 86، which is indicating good validity of the Persian version of the tools. Also by shortening Persian version of the above tools، answering themwould be easier.

Patients’ unstable clinical conditions require critical care nurses to be competent decision makers. Standardized patient is a new teaching strategy which can enhance nurses’ decision making ability. The purpose of this study was to examine the effects of teaching by using standardized patients on critical care nurses’ decision making ability. This two-group pretest-posttest quasi-experimental study was conducted in 2014. The study setting was Shahid Kamyab and Imam Reza Hospitals, Mashhad, Iran. These two hospitals were randomly allocated to either control or experimental groups. Then, several intensive care units were randomly selected from each hospital. Nurses were recruited from the selected units. In total, 58 nurses were studied. The study intervention consisted of educations about clinical decision making. Educations in the control and the experimental groups were provided by using the lecture and the standardized patient strategies, respectively. Nurses’ clinical decision making ability was evaluated both before and 45 days after the study intervention by employing the Participation Decision Activity Questionnaire. The study data were analyzed by using the SPSS v. 16 the statistical tests of paired- and independent-samples t, Chi-square, Mann-Whitney, and Wilcoxon. Before the intervention, the means of the three steps of decision making in the experimental group (32.1±10.2, 33.4±9.3, and 32.1±9.7, respectively) did not differ significantly from the control group (31.1±7.8, 32.2±6.4, and 31.4±6.5 respectively). However, after the study, the differences between these groups regarding the means of the three steps of decision making were statistically significant (p<0.001). Moreover, in the experimental group, the pretest-posttest mean differences of the three steps of decision making (17.6±7.9, 18.07±7.5, and 19.1±8.1, respectively) were significantly higher than the control group (3.8±4.2, 4.0±2.9, and 5.6±3.5, respectively; p < 0.001). Teaching through standardized patients can significantly enhance nurses’ clinical decision making ability. This strategy can be used for developing in-service continuing education programs and improving nurses’ clinical decision making ability.

In the absence of a gold standard for the clinical diagnosis of shock, clinicians traditionally rely on measurements of vital signs, arterial oxygen saturation of hemoglobin (SaO2), serum lactate, and arterial base deficit. Yet values derived from these measurements may remain relatively normal during the early stages of shock while the patient’s condition is indeed deteriorating, and the evolution from mild to severe shock can be subtle or extremely rapid. Tissue oxygen saturation (StO2) monitoring is a noninvasive technology that has been reported to function as an early warning sign of tissue hypoxia, as systemic blood flow is redistributed to critical organs, primarily in patients with hemorrhagic and traumatic shock, but also in patients with septic shock and in those undergoing cardiac surgery. This pilot study examined the strength of the relationship between initial postoperative StO2 values and the development of complications in adult patients. This observational, prospective study was carried out in a convenience sample of 31 hemodynamically stable, postoperative adults admitted to the Post-Anesthesia Care Unit (PACU) and Cardiothoracic Care Intensive Care Unit (CTICU) at a 643-bed Level I trauma medical center in the Northeastern region of the United States during 2012. Institutional Review Board approval was obtained from the university and the medical center. Patients were approached in the preoperative holding area, the study was explained, and patients were shown the equipment that would be used in the study. After the patient had been admitted to either the PACU or CTICU, the investigators waited until the bedside nurse performed an initial assessment of hemodynamic stability. Following calibration of the InSpectra monitor, the StO2 probe was placed adhesively on the thenar eminence of the patient’s hand. The StO2 data was monitored continuously, downloaded to a laptop computer, and recorded manually every 15 minutes for at least 2 hours. The first, last, and average StO2 values were, respectively: 80.71%+9.16; 80.94%+7.07; and, 80.56% +7.18. However, the mean minimum values of the first, last, and average StO2 values were, respectively: 55%, 67%, and 65%. When minimum StO2 values were tested for differences in the incidence of postoperative complications, there was a significant difference (x=76.9+7.44, range 59-92; Chi Sq, df 18, p=0.020). While postoperative patients maintained a stable level of StO2 values during their early recovery, a case report illustrates that sudden drops in StO2 values may be sensitive to the detection of the potential for complications.

One of the most important nursing interventions for the patients using endotracheal tube is on time and accurate discharge of respiratory tract secretions. Improving nurses’ performance in taking care of the newborns with endotracheal tube is an important factor in reducing side effects of frequent suctioning and acceleration in patients’ improvement. This study has been done in order to “assess nurse's performance in endotracheal tube suctioning in Neonatal Intensive Care Units (NICU)”. It is a descriptive-cross sectional study. 48 nurses working in NICU of the training hospitals affiliated to Ahvaz Medical Sciences University were chosen through census method in 2014. A questionnaire was prepared to assess nurse's performance before, during and after endotracheal tube suctioning and to compare their performance according to suctioning standard procedure; the questionnaire was consisted of demographic information and a standard checklist regarding endotracheal tube suctioning. Data analysis was done through using descriptive statistical test and SPSS 19 software. 83.4 percent of the workers were women and 16.6 percent were men and they were 26-35 years old. 54.1 percent had attended intensive care in service-training. 52.1 percent of the nurses had 5 years or less working experiences in ICUs. 64.6 percent had good performance and 35.4 percent had medium to poor performance. According to the results of the present study, most of the nurses working in ICUs had good performance regarding endotracheal tube suctioning. So it is necessary to consider in-service training regarding correct and appropriate endotracheal tube suctioning for those who did not have good performance too, since lack of appropriate performance of endotracheal tube suctioning by a small number of nurses might be dangerous for the patients hospitalized in ICUs.

Restless leg syndrome is a sensorimotor disorder characterized by restlessness and irritability in legs mainly during nighttime immobility. It can occur secondary to cardiovascular disease. The aim of this study was to examine the correlation of restless leg syndrome with sleep disorders among hospitalized patients with acute coronary syndrome. This descriptive-analytical study was conducted in 2012. A random sample of 221 patients with acute coronary syndrome was drawn from the coronary care unit of Imam Ali Hospital, Kermanshah, Iran. Sleep disorders and restless leg syndrome were evaluated by using the researcher-made Cardiac Patients’ Sleep Disorders Inventory. The SPSS v. 16.0 was used for data management and analysis. The mean of participants’ age and the prevalence of restless leg syndrome among them were 61.27 years and 65.1%, respectively. Most of the patients (61.5%) were male. The prevalence of restless leg syndrome among patients with and without sleep disorders was 70.8% and 20%, respectively. Restless leg syndrome was significantly correlated with sleep disorders (p < 0.001). Restless leg syndrome is rather prevalent among cardiac patients. However, it usually remains undiagnosed and untreated. Consequently, performing diagnostic screening tests for identifying cardiac patients with this syndrome as well as implementing interventions such as muscular relaxation, massage, and sleep promotion techniques for managing it are recommended.

Warfarin is one of the most prescribed medications in the United States for prevention both stroke and venous thromboembolism. There are numerous demographic and medical factors that can potentially complicate successful warfarin management. Patient adherence to warfarin regimens is largest determining factor of anticoagulation therapeutic effectiveness. This study aimed to determine the Relationship of demographic factors with medication adherence among Patients attending in Warfarin Clinics in Tehran was designed and conducted. This cross-sectional descriptive study was conducted on 400 eligible patients. Subjects were selected based on target. Demographic questionnaire, Modified Morisky medication adherence questionnaire, INR test and visit to the clinic were used for data collection. Of 400 patients studied, 61% were woman with mean age (± standard deviation) 52.97 ± 13.32, 57.8% had adherence with Modified Morisky medication adherence questionnaire, 73.5% had INR in therapeutic range, 38% had regular visit and 27.8% of participants had adherence with per three instruments. Adherence was related education (p=0.000), life status (p=0.041), employment status (p=0.000), home area (p=0.012) and income (p=0.002). Adherence is a behavioral multifactorial process and the role education, employment status, socioeconomic status and life status of patients in that is important. Therefore, to improve adherence, nurses should consider this factors in educational programs for these patients.

Identifying and modifying factors such as inadequate dialysis and consequently disability and mortality that may influence hemodialysis patient's quality of life can cause more appropriate level of health in these patients. This study is done with the aim of "determining relationship of quality of life with dialysis adequacy and laboratory parameters in hemodialysis patients". In this cross-sectional study, 99 hemodialysis patients were investigated through convenient sampling in 2013. The tools of the study included: quality of life questionnaire specialized to dialysis patients, KT/V for determining dialysis adequacy and albumin, Hemoglobin, Fasting Blood Sugar (FBS), creatinine, Bilirubin, Potassium, Sodium, Calcium and Phosphorus laboratory parameters. After collecting data, the relationship between them was determined. SPSS16 software, Pearson correlation and ANOVA statistical tests were used for data analysis. quality of life and dialysis adequacy of the subjects of the study were not in an appropriate level. There was a significant difference (p<0.05) between quality of life and dialysis adequacy. Also there was a significant statistical correlation between the score of quality of life and albumin, hemoglobin, bilirubin, creatinine, potassium, calcium and phosphorus parameters (p<0.05). But there was no significant correlation between FBS and Sodium with the score of quality of life. more appropriate level of quality of life can be achieved for these patients through planning and implementing nursing interventions regarding increase of dialysis adequacy and improvement of some parameters.

The delivery of developmental care in neonatal intensive care units helps save neonates’ energy, maintains their physiologic stability, reduces their and their families’ stress, shortens their hospital stay, and cuts healthcare costs. This study was undertaken to determine the rate of developmental care delivery in neonatal intensive care units. This cross-sectional descriptive study was conducted in 2012–2013. We used the census method and recruited 138 critical care nurses from neonatal intensive care units of nine teaching hospitals affiliated to Tehran University of Medical Sciences, Tehran, Iran. The data collection tool was a questionnaire developed by using the findings of a study conducted by Coughlin et al. (2009). Data analysis was carried out with SPSS v. 20.0 and by using descriptive statistics measures and inferential statistics tests such as the independent-samples t. The rates of delivering the five dimensions of developmental care were as follows: Daily routine care: 79.46%; Protected sleep: 65.43%; Provision of a healthy environment: 65.27%; Family-centered care: 63.32%; and Pain and stress assessment and management: 66.53%. The total rate of developmental care delivery was 66.53%. Developmental care delivery is not a common practice in neonatal intensive care units. Consequently, more efforts are needed for enhancing the rate of delivering developmental care. Strategies such as educating families and neonatal critical care nurses, developing and enforcing developmental care guidelines by public health authorities, and supervising care measures can enhance the rate and the quality of developmental care delivery.