فهرست مطالب

پرستاری مراقبت ویژه - سال دهم شماره 2 (پیاپی 34، May 2017)

نشریه پرستاری مراقبت ویژه
سال دهم شماره 2 (پیاپی 34، May 2017)

  • تاریخ انتشار: 1396/01/08
  • تعداد عناوین: 7
|
  • Maryam Heidari, Salman Yadollahi, Zahra Rafiee, Mousa Karimifard, Hedayatollah Lalehgani * Page 1
    Background
    Health care services are associated with risks for their recipients. Medication errors can lead to many negative consequences for the health care system, including prolonged hospital stay and increased cost per patient. The aim of this study was to investigate the nursing staff’s perspective regarding reasons for medication errors in Ayatollah Kashani hospital, Shahrekord, Iran.
    Methods
    207 nurses working in the ICUs of the hospital were selected by convenience sampling and their comments about effective factors in the incidence of medication errors were investigated by a researcher-made questionnaire. To examine the reliability and validity of the questionnaire, we offered it to 5 nursing experts and necessary corrections were made based on the comments. The reliability of the questionnaire was also investigated by Cronbach’s alpha coefficient that gave the value of 85%. The first section of the questionnaire consisted of questions about demographic characteristics and the second section investigated the reasons for medication errors in nursing-related area, workplace-related area, director of nursing-related area, and drug-related area. For each item, there were four choices, i.e. none, little, moderate, and much and therefore, the level of importance scored between 0 and 3. The data were analyzed by SPSS 17.
    Results
    In this study, the most important reasons for medication errors were related to workload-induced fatigue (mean: 2.37) in the nurses-related area, high labor-intensity in department (mean: 2.32) in the workplace-related area, insufficient nursing staff proportional to the number of patients in department (mean: 2.41) in the director of nursing-related area, and drug name confusion in the drug-related area (mean: 2.04).
    Conclusions
    The officials of health care systems should focus on the effective processes in reducing medication errors including appropriate training of the staff and holding in-service training sessions about drug information as well as appropriate planning for employment of adequate workforce.
    Keywords: Medication Errors, Nurse's Perspectives, Patient Safety
  • Saeed Ghasemi, Hosien Babatabar Darzi *, Abbas Ebadi Page 2
    Background
    Complementary therapies are cost-effective and non-invasive methods, aimed at increasing comfort in stressful situations. The aim of this study was to compare the effects of aromatherapy with rose and lavender fragrances on the physiological parameters of patients undergoing open heart surgery.
    Methods
    This randomized, controlled, clinical study was performed on 160 patients, undergoing open heart surgery in 2015. The patients were randomly allocated to 4 groups: 2 intervention groups, 1 control group, and 1 placebo group. After transferring the patients from the operating room to the cardiovascular intensive care unit (ICU), the vital signs were documented in all the groups with the patient’s first inspiratory effort, using a monitoring device. In the intervention group, after the patient’s first inspiratory effort, a cotton cloth, impregnated with 3 drops of rose and lavender fragrances, was attached to the patient’s endotracheal tube. In the placebo group, intervention was performed with a cotton cloth impregnated with water. In the control group, no intervention was applied. Afterwards, the patients’ vital signs were controlled and documented every 30 minutes until the endotracheal tube was extracted. Following endotracheal tube extraction, the vital signs were documented every 15 minutes for 1 hour. For data analysis, descriptive and inferential statistics were calculated, using SPSS version 23.
    Results
    The results of the present study indicated that aromatherapy with rose and lavender fragrances does not cause any significant difference in the physiological indicators. The decline in systolic blood pressure within the first 15, 45, and 60 minutes following endotracheal tube extraction was significantly different among the groups. However, although the difference was statistically significant, it was not of clinical importance.
    Conclusions
    Considering the positive effects of aromatherapy on hemodynamic indicators, this method can be applied as an effective complementary treatment.
    Keywords: Aromatherapy, Physiological Parameters, Open Heart Surgery
  • Leila Safaeepour, Jamileh Mokhtari Nouri *, Seyed Tayeb Moradian, Seyed Mohammad Saied Ghiasi Page 3
    Background
    The use of nonpharmacological methods has been emphasized in the recent years. These methods are used to decrease the duration of weaning from mechanical ventilation after coronary artery bypass graft (CABG) surgery.
    Objectives
    The present study aimed at determining the effect of family-centered care on the duration of weaning from mechanical ventilation in patients undergoing CABG.
    Methods
    This clinical trial study was conducted in Jamaran Heart Subspecialty hospital in Tehran in 2016. Initially, convenient sampling method and random allocation were used by quaternary blocks to allocate patients into 2 groups of experimental and control, with 35 participants in each group. In the intervention group, the patients’ family member chosen by the patient was entered into the ward during the weaning process. Patient’s entrance time to the ward to extubation time was considered as the duration of weaning from mechanical ventilation in the 2 groups.
    Results
    Duration of weaning in the experimental group was 97 minutes less than the control group; in other words, the weaning duration of those in the control group was 1.4 times greater than those in the experimental group. This difference was statistically significant between the 2 groups (P = 0.05).
    Conclusions
    Family-centered care reduced the duration of weaning from mechanical ventilator in patients undergoing coronary artery surgery, which can remarkably decrease complications due to ventilation with positive pressure in these patients.
    Keywords: Family, Centered Care, Mechanical Ventilator, Coronary Artery Bypass Graft (CABG), Weaning, Clinical Trial
  • Amir Hossein Goudarzian, Mansour Ranjbar, Mahdi Babaei Hatkehlouei, Alimorad Heidari Gorji * Page 4
    Background
    Time management is significantly important in nursing, because wasting time and inappropriate management have negative effects on patients’ health.
    Objectives
    The present study aimed at determining the rate of time management in Iranian critical care nurses and its related factors.
    Methods
    This descriptive-analytical study was conducted on critical care nurses of hospitals affiliated to Mazandaran University of Medical Sciences in 2016. Of 500 nurses from all the selected hospitals, 410 ones accepted to participate in the study, with response rate of 91.1%. The instruments for data collection were demographic characteristics and time management questionnaires. Data were analyzed by descriptive and inferential statistic tests (Pearson correlation, one-way ANOVA, independent sample t test, and General Linear Model).
    Results
    In this study, 100 male (24.39%) and 310 female nurses (75.6%) took part, with the average age of 37.58 ± 7.37 (CI95: 36.82 - 38.33). The rate of time management in the nurses under the study was 107.68 ± 18.011 (CI95: 105.83 - 109.54). Moreover, 35 (8.5%), 275 (67.07%), and 100 nurses (24.39%) had low, medium and good levels of time management, respectively. A significant relationship was observed between time management and age (r = 0.506, P
    Conclusions
    Time management is necessary for medical workers, especially nurses. Also, it would be interesting to conduct comparative cultural studies to better evaluate time management.
    Keywords: Time Management, Iran, Nurses, Critical
  • Kobra Esfandani, Shahla Aliyari *, Amir Hossein Pishgooei, Abbas Ebadi Page 5
    Background
    Advanced nursing practice necessitates using research findings and evidence as well as effective clinical decision making. The use of evidence in nursing practice is not only a duty, but also a professional responsibility and practice.
    Objectives
    The current study aimed at assessing the effects of an evidence-based practice training workshop on the information literacy of critical care nurses.
    Methods
    The current 2-group, pretest-posttest, quasi-experimental study was conducted in 2016. A convenient sample of 90 critical care nurses was selected. Nurses were non-randomly allocated to a control and an experimental group 45 subject each group. An 8-hour evidence-based practice training workshop was held in 2 consecutive days for nurses in the experimental group, while nurses in the control group received no evidence-based practice training. A researcher-made valid and reliable questionnaire was used to measure the information literacy in nurses. The collected data were analyzed using the SPSS software version 19, and via running the Fisher exact, the paired- and independent-sample t tests.
    Results
    At baseline, the mean score of information literacy in the control group did not differ significantly from that of the experimental group (9.668 ± 5.11 vs. 8.84 ± 4.37; P value = 0.40). After the study, these values increased to 10.51 ± 5.03 and 23.75 ± 3.07, respectively. Intergroup differences regarding the posttest information literacy score was statistically significant (P value
    Conclusions
    The evidence-based practice training significantly promotes the information literacy in critical care nurses and paves the way for the use of evidence in their clinical practice.
    Keywords: Nurses, Care, Evidence, Based Practice, Information Literacy
  • Isabella Panfoli * Page 6
    Context: Hyperglycemia after resuscitation in both critically-ill adults and preterm newborns is associated with increased mortality and poor brain outcome. Lactose, composed of 50% glucose and 50% galactose is the unique means Nature offers to the newborn, who in absence of modern care suffers from severe bioenergetic impairment, similarly to adults resuscitated after cardiac arrest. Aim of this study is to review these issues, to understand how we may improve outcomes in intensive care units.
    Evidence Acquisition: A review study was conducted in 2017 through searching on Science Direct, PubMed, Wiley, and Blackwell databases. The search was performed using bioenergetics, cardiac arrest, critical illness, hyperglycemia, glucose, galactose, newborn and resuscitation, as key words. Finally, 24 articles in English were assessed in this study, thereby comprised 2 guidelines (2015 American heart association and guidelines for both Adult and Neonatal Resuscitation.
    Results
    Correct glycemic control strategy in extreme ATP deficit conditions, such as after resuscitation from a cardiac arrest or a complicated or preterm birth can improve outcome. 2015 American heart association (AHA) guidelines do not recommend glucose infusion after cardiac arrest. Data on glucose administration following brain insult in newborn are limited. Outcomes of applying the hypothesis allowed to assess that glucose, an excellent substrate, turns to a harmful one, able to worsen brain outcome, likely due to its needing phosphorylation prior to be utilized. Un-phosphorylated galactose can be utilized by Hexose phosphate dehydrogenase.
    Conclusions
    Awareness that conditions of extreme cellular ATP deficit may lead to a vicious cycle in which glucose would not be freely available as a substrate may rise studies for applying new strategies in clinical practice in the future. The need to balance among the opportunity to avoid both hypo- and hyper-glycaemia tells us that we may have missed the opportunity to learn from Nature how to care for both resuscitated newborns and critically-ill adults. A far-fetched hypothesis arises that to ameliorate long-term brain outcomes, we may imitate Nature which, to start up glucose catabolism, offers a solution composed of 50% glucose and 50% galactose.
    Keywords: Resuscitation, Newborn, Cardiac Failure, Glucose, Galactose, Hyperglycaemia