فهرست مطالب

پرستاری مراقبت ویژه - سال نهم شماره 4 (پیاپی 32، Nov 2016)

نشریه پرستاری مراقبت ویژه
سال نهم شماره 4 (پیاپی 32، Nov 2016)

  • تاریخ انتشار: 1395/10/08
  • تعداد عناوین: 8
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  • Mahnaz Khatiban, Khodayar Oshvandi, Seyed Reza Borzou, Malihe Sadat Moayed* Page 1
    Background
    Applying theories in clinical practices is an important factor in development of nursing science and reduction of the gap between theory and practice. The aim of this study is to assess outcomes of applying Neuman system theory in intensive care units.
    Methods
    A review study was conducted in 2016 through searching on Cochrane Library, Science Direct, Ovid, Google scholar, PubMed, Wiley, ProQuest, and Blackwell databases. The search was performed by using ICU, critical care, defense line, client system, nursing, and neuman system model as key words. Finally, 7 articles in English were assessed in this study, comprised of 5 quantitative studies, 1 qualitative study, and 1 case report study.
    Results
    Outcomes of applying the theory were assessed in three categories including: 1. Caregivers (nurses), 2. Care receivers (patients and their families) and, 3. Intensive care unit environment. Regarding nurses, the results indicated an improvement in supporting of nurses, creating a social network in the workplace, and preventing post-traumatic disorder by using three prevention levels. Regarding patients and their families, identifying environmental stressors and controlling them resulted in high quality care and by using evidence-based care, it led to the prevention of delirium. Family was found to have an important role in terms of the created environment and acceleration in patients’ improvement; regarding factors related to the unit, creating a relaxing environment by playing music resulted in stress reduction.
    Conclusions
    Correct evaluation of the elements of treatment process leads to identify different kinds of stressors in nurses, patients, clients’ families, and intensive care unit environment as well as providing appropriate strategies which can cause stress reduction and subsequently satisfactory treatment outcomes. Achieved knowledge and awareness may lead to new studies for combining theory with clinical practice. This new knowledge can provide dynamic and scientific care.
    Keywords: Neuman System Model, Stress, Critical Care, Nursing Theory
  • Seyed Ali Majidi, Amir Ashkan Nasiripour* Page 2
    Background
    The emergency department is the heart of every hospital and regular circulation of tasks in this unit can save countless lives. Quality of services provided at emergency departments is of particular importance and performance improvement is considered as one of the most important processes in emergency departments.
    Objectives
    The aim of this study was to determine performance improvement priorities of emergency departments of Iran’s hospitals.
    Methods
    This research was a cross-sectional study. First, a systematic review was conducted and performance improvement priorities of the emergency department were identified and designed as a questionnaire in five areas: communication, teamwork, clinical pathway, patient flow and other factors. During October 2015, after examining the content validity index (CVI) and content validity ratio (CVR), the questionnaires were given to 200 hospital emergency experts (doctors and nurses) across the country. After collecting the questionnaires, the data were entered into the SPSS software and analyzed.
    Results
    In a comparative investigation of the scores of different areas of performance improvement of emergency department of the country’s hospitals based on Friedman test, from the perspective of the emergency department staff, the average score of these areas was significant (P
    Conclusions
    Priorities set by emergency workers in various areas such as communication, teamwork, clinical pathway and patient flow, play a significant role in the performance improvement of the emergency department.
    Keywords: Hospital, Priority Setting, Performance Improvement, Emergency Department
  • Ziba Asadpoordezaki, Afsaneh Barabady, Dariush Abtahi * Page 3
    Background
    Hand disinfection is a major part of infection control during a surgical procedure. In contrast to developed countries, where the use of alcohol-based solutions (ABS) is routine, the usual practice in Iran is hand scrubbing using Povidone Iodine Solution (PVI). Most researchers have concluded that ABS might be superior to PVI, but others have found no differences. In this study the disinfection efficacy of ABS was compared to PVI.
    Methods
    Thirty-one volunteers including surgeons and operating room nurses (OR-nurses) participated in this cross over design study. For one week they used ABS and the next week they used PVI for pre-surgical hand disinfection. Samples were obtained from the hands of all participants before, immediately after and two hours after hand washing. The bacterial contamination rate was evaluated by a microbiologist.
    Results
    Our results demonstrated that ABS led to significantly lower mean Colony Forming Units (CFU) immediately after hand disinfection, but no significant differences were found between the two groups after two hours. Also, alcohol-based solution revealed a significantly higher logarithmic reduction factor (RF) of skin flora as an instantaneous effect. Both solutions were effective against Staphylococcus aureus, but the minimum reduction rate was in eliminating the Bacillus group.
    Conclusions
    In conclusion, ABS can be promoted as the best choice for surgical hand disinfection solution amongst emergency situations, in that it has a time saving character and better instantaneous effect on bacterial skin flora reduction.
    Keywords: Infection, Hand Disinfection, Cross Infection, Patient Safety
  • Haydeh Heidari, Marjan Mardani Hamooleh* Page 4
    Background
    The neonatal care in the first few minutes after birth could affect the newborn’s quality of personal life and thus its entire lifetime.
    Objectives
    The aim of this study was to examine the integration of the newborn resuscitation-training program in pediatric nursing teaching.
    Methods
    The present study was a mixed-method study, which began with qualitative and quantitative data collection at the same time. That is why the qualitative and quantitative steps performed at the same time. The qualitative phase was conducted based on the qualitative content analysis. Purposeful sampling was performed. Saturation occurred with10 interviews. The quantitative phase was performed based on a researcher-made questionnaire. The content validity of the questionnaire was confirmed by the feedback of experts and its reliability was assessed by Cronbach’s alpha 92%. The number of students at this stage was 48.
    Results
    Based on the results of the qualitative phase, two main categories of clinical skills promotion and the necessity of attention to educational needs of students were obtained, which was in accordance with the results of the quantitative step. Based on the results of the quantitative step, the following results were obtained: areas of the resuscitation-training program improved my skills (83% strongly agree and 17% agree); I am satisfied with resuscitation-training program (94% strongly agree and 6% agree); I agree with continuing resuscitation program in future terms (77% strongly agree, 21% agree, and 2% disagree); the resuscitation-training program conformed with students’ needs (92% strongly agree, 4% agree and 2% disagree); and the quality of resuscitation training program was appropriate (94% strongly agree and 6% agree).
    Conclusions
    Performing the newborn resuscitation for nursing students and increasing their knowledge and skills may lead to increase student motivation, reduce hospital costs and increase the quality of care.
    Keywords: Resuscitation, Mixed, Method Research, Pediatric Nursing, Students
  • Maliheh Kadivar, Nayeemeh Seyedfatemi, Mitra Zolfaghari, Abbas Mehran, Zohreh Hossinzade* Page 5
    Background
    Self-efficacy has an influence on nurses’ professional progress, motivation, effort, perseverance, and time spent by learners on learning. It is also an interface between knowledge and practice. This study aimed to assess the impact of virtual-based education on self-efficacy of nurses in level II neonatal intensive care.
    Materials And Methods
    In this quasi-experimental study, after determining the sample size (n = 80), nurses working in level II neonatal care unit of hospitals affiliated to TUMS were randomly divided into two groups. The study was conducted in 2015. Nurses’ self-efficacy level was measured in the two groups by using Coates self-efficacy questionnaire on the first day of the study. For the intervention group, education content of level II neonatal care was developed and run on Namad system of the virtual faculty of TUMS for two months. No specific intervention was performed for the control group. At the end of the education course, nurses’ psychological empowerment was reassessed in both groups by using the mentioned questionnaire. Data analysis was performed by using the paired t-test, Fisher exact test, chi-square, and independent t-test in SPSS 23.
    Results
    Research units were similar in terms of all demographic variables other than work experience in neonatal unit. Mean and standard deviation of self-efficacy scores in the control and intervention groups before the intervention were 129.7 ± 13.973 and 118.05 ± 11.104, respectively, while mean and standard deviation of the two groups after the intervention were 128.09 ± 12.363 and 136.11 ± 9.830, respectively. There was a statistically significant difference in the mean score of self-efficacy between the two groups before the intervention P ≤ 0.001), self-efficacy mean score in the control group before and after the intervention (P = 0.002), self-efficacy mean score in the intervention group before and after the intervention (P ≤ 0.001), and self-efficacy mean score between the two groups after the intervention (P ≤ 0.004).
    Conclusions
    The results of the present study indicate the effectiveness of virtual education in increased self- efficacy of nurses in level II neonatal intensive care unit. With regard to the advantages of virtual education, it can be employed as a modern educational method to provide necessary requirements and tools for training nurses and other healthcare givers.
    Keywords: Virtual Education, Self, Efficacy, Neonatal Unit Nurse, Education
  • Seyed Tayeb Moradian, Abbas Ebadi, Fakhraddin Faizi, Mohammad Hasan Kalantar Motamedi, Mohammad Saeid Ghiasi * Page 6
    Background
    The incidence of acute kidney injury commonly follows cardiac surgery. Some studies have demonstrated better outcomes following off-pump cardiac surgery.
    Objectives
    This study was conducted to compare the incidence of acute kidney injury and laboratory findings in patients undergoing cardiac surgery with or without cardiopulmonary bypass.
    Methods
    In a retrospective study, 167 patients who underwent coronary artery bypass grafts (CABG) with or without cardiopulmonary bypass were selected by systematic randomized sampling method from the list of Jamaran heart hospital (Tehran) patients and the incidence of acute kidney injury and laboratory findings were compared.
    Results
    There was no significant difference in the demographics (age, sex, drug history, and chronic disease) between the groups (P > 0.05). The acute kidney injury (AKI) was observed in 19.3 and 33.7% of the off-pump and on-pump patients, respectively. A total number of16 (19.3%) in the off-pump and 44 (52.9%) in on-pump group needed blood transfusion. The mean hospital stay was 6.74 ± 1.86 days for OPCAB and 7.2 ± 1.72 for on-pump patients. Haemoglobin and haematocrit level, also, were higher in OPCAB.
    Conclusions
    This study showed that off-pump coronary artery bypass (OPCAB) is superior in acute kidney injury, blood transfusion, blood glucose management, and hospital stay. Considering these complications and those adverse effects, it seems that off-pump technique is better in selected patients, but it is proposed that more prospective multi-disciplinary studies with larger sample sizes should be done.
    Keywords: Coronary Arteries Bypass Surgery, Acute Kidney Injury, Cardiopulmonary Bypass, Laboratory Findings
  • Amin Koohsariyan, Tahereh Nasrabadi *, Mohammad Zare Page 7
    Background
    Sleep apnea is one of the respiratory problems during sleep and about 50% of cardiovascular patients suffer from sleep apnea. On the other hand, cardiovascular diseases are increasing in our country. Therefore, nurses working in critical care units should have a special approach towards sleep disorders of hospitalized cardiovascular patients.
    Objectives
    This study aimed to assess sleep respiratory apnea in cardiovascular patients.
    Methods
    In this descriptive study, 76 cardiovascular patients were selected through random sampling from Baqiyatallah Hospital in Tehran, Iran, during 2015 - 2016. They were assessed in terms of respiratory apnea during sleep. A total of 51 patients finished review processes completely. The Epworth sleep scale (ESS ), which is a standard questionnaire, was used to assess sleep apnea. The subjective findings were assessed using the overnight polysomnography test. Data were analyzed using inferential statistics by the SPSS 19 software.
    Results
    In this study, 66.7% of the patients were males and 33.3% were females. The mean age of the patients was 55.01 ± 12.1. The mean ESS score of the patients was 15.1 ± 5.1. 15. Ninety-two percent of the patients had sleep respiratory apnea. The mean score of sleep respiratory disorders of cardiovascular patients was 33.05 ± 4.6. The lowest score of sleep respiratory disorders was 3 and the highest score was 126.8.
    Conclusions
    Sleep apnea during sleep is a common finding in cardiovascular patients. Therefore, the quality of life of these patients should be improved through timly assessment of cardiovascular patients’ sleep disorders. Also, nurses can be effective in decreasing complications and associated problems of these patients through assessing patients’ sleep pattern and referring them to clinics that assess sleep disorders.
    Keywords: Sleep Apnea, Cardiovascular Patients, Sleep Respiratory Disorders
  • Mehdi Naseri, Ali Rahmani *, Batool Nerir, Mehdi Salari, Maryam Moshkani Farahani Page 8
    Objectives
    Cardiovascular diseases, especially coronary artery diseases, result in sleep disturbance. Myocardial muscle oxygen demand rises in sleep disturbance. Also, the possibility of cardiovascular risks such as re-infarction and dysrhythmias increases. As a result, removing sleep disorders is very important. The current study aimed at assessing the effect of foot reflexology massage and foot bath methods on sleep quality of the patients with acute coronary syndrome (ACS) through a comparative study.
    Methods
    The current semi-experimental study was conducted on 3 groups of patients with ACS admitted to coronary care units (CCUs) of Baqiyatallah (AJ) hospital of Tehran, Iran. Samples of the study included 35 patients for each group (105 patients in all the groups) selected among the available hospitals and divided into 3 groups (foot reflexology massage, foot bath, and control) through random allocation. According to the related program, patients of the intervention groups were under intervention for 2 nights from the 2nd night of hospitalization and sleep quality was assessed through Verran and Snyder-Halpern (VSH) subjective sleep quality questionnaire before and after the intervention. Then, data analysis was done through SPSS version21 by descriptive and inferential statistics.
    Results
    There was no significant statistical difference among the 3 groups regarding sleep disturbance and supplementary sleep after interventions (P > 0.05), but there was a significant statistical difference between the groups and at different time regarding the effectiveness after intervention (P
    Conclusions
    Foot massage and foot bath positive effect on the sleep quality of patients with ACS can be used as a complementary action.
    Keywords: Acute Coronary Syndrome, Foot Bath, Foot Reflexology Massage, Sleep Quality