نشریه پرستاری مراقبت ویژه
سال دهم شماره 4 (پیاپی 36، Nov 2017)

Emergency room functions as the heart of a hospital, and caring is the essence of nursing in any hospital.
This study conducted to illuminate the process of caring in an emergency ward based on experiences of nurses and patients.
The theory of caring was extracted using the grounded theory design as a qualitative research methodology. In-depth interviews with 18 nurses and 7 patients were conducted using purposive and theoretical sampling. Observation and field notes method was also used. Data were analyzed using constant comparative analysis of Strauss and Corbin.
Situation stabilizing was defined as the core concept in participants’ strategies to overcome their concern. In this basic psychosocial process, some factors functioned as a facilitator and other as a barrier.
When the final theory is appropriate to the field, it is more easily understood, and the participants apply the theory more easily, faster, and better. This leads to favorable outcomes such as patient and nurse satisfaction, reduction in crowdedness and stress, effective clinical management, increased speed, and accuracy and comprehensiveness in providing care in the emergency ward.

Delirium is the most common neurological diagnosis with a high occurrence among patients hospitalized in intensive care units (ICUs). Nurses should be able to connect with these patients and improve the prevailing mood in ICUs. Qualitative research attempts to discover people’s views and thoughts and understand the depth of issues through their experiences. The present qualitative study aimed to explore ICU nurses’ experiences of care provision for delirious patients.
The present study is a conventional qualitative content analysis of ICU nurses’ (n, 27) experiences of care provision for delirious patients in Guilan Province, Iran in 2016. The study population was selected through purposive sampling, and the data were gathered through semistructured individual interviews, which continued until data saturation. Data analysis was performed in every stage, as recommended by Graneheim and Lundman. The strength and scientific accuracy of the study were evaluated, based on the Lincoln and Guba’s criteria.
Data analysis indicated 2 main themes and 6 subthemes. The main themes included “troubled relationships” (subthemes: “poor relationships”, “inadequate support”, and “categorized relationships”) and “exhaustive care provision” (subthemes: “exhaustion from devotion”, “occupational fatigue”, and “fruitless caring”).
Based on the results of the present study regarding nurses’ care experiences for delirious patients in ICUs, patients can be relieved from disease-related tension, especially delirium, through strengthening nurse-patient relationships. Moreover, the staff’s healthy relationship with one another, besides managerial support, can improve occupational relationships and provision of care services.

Playing is one of the recommended tools in recent years for decreasing pain in children having painful and stressful experiences. It can also help these children cope with such situations.
This study was performed with the aim of assessing the effect of a multidimensional play program on pain intensity during wound dressing change in children hospitalized in burn intensive care units.
In this clinical trial, forty 7 to 12-year-old children, hospitalized in burn intensive care units of Imam Mousa Kazem (SA) medical educational center in Isfahan, were selected through simple random sampling and were divided into 2 groups. The multidimensional play program was applied for children in the experimental group. Finally, pain intensity was assessed in the groups, using Wong-Baker’s pain rating scale. In addition, the results were documented in the pre and posttest stages, and data analysis was performed using statistical tests.
The children’s average pain scores of burn dressing change before and after the intervention were 8.6 ± 0.9 and 5.5 ± 1.3 in the experimental group and 8.7 ± 0.8 and 8.4 ± 0.8 in the control group, respectively. According to the t test results, there was a significant difference between the groups in terms of pain intensity after burn dressing change in the posttest (P This study indicated that application of a multidimensional play program can be useful in decreasing children’s pain intensity during burn dressing changes.

The hope therapy program has rarely been used for heart patients and little information is available on individual Hope therapy.
The present study was conducted to evaluate the effect of the individual Hope Therapy program on reduction of depression in elderly patients with unstable angina hospitalized in the CCU.
This clinical trial study was performed in the CCUs of hospitals in Tonekabon city in 2016. The research population included elderly patients with unstable angina. The subjects were randomly divided into 2 groups of 16, the intervention and control groups. The data were collected before, 1 week later, and then 1 month after the intervention. A short cognitive questionnaire collected demographic information of the elderly at the beginning of the study through a face-to-face interview. A hospital depression questionnaire was performed before the intervention as well as 1week and 1 month after the intervention.
Results of the variance analysis of the repeated measures test showed that depression scores in the experimental group were significantly lower than that of the control group 1 month after performing the protocol. However, the scores did not have any significant difference in both the control and experimental group 1week after the program was ended. P = 0.112 Eta = 0.070.
The results of this study showed that Hope Therapy reduced the level of depression scores in the intervention group compared with the control group in 3 steps, these results are stable.

Anxiety and worry about the future, depression and grief caused by loss of health, along with: physical problems, decreased efficacy and self-confidence, and social isolation damage the spiritual health of hemodialysis patients. The aim of this study was to investigate the effect of spiritual care based on sound-heart consulting model on the spiritual well being of hemodialysis patients.
In a semi-experimental study, in the dialysis department of Baqiyatallah hospital in Tehran, 38 patients under hemodialysis were selected according to the inclusion criteria. Regarding outpatient care, spiritual care was carried out in the form of spiritual counseling based on the sound-heart consulting model. During the 8 volunteering counseling sessions, spiritual skills were taught to improve the four-dimensional relationship (relationship with God, self, others, and the universe of nature) with an educational booklet. The spiritual health of patients with Alison’s questionnaire was examined before intervention, immediately after counseling and 3 months later. Data were analyzed with descriptive statistics (mean, standard deviation) and inferential statistics (Chi-square, t-test, Fisher exact test, Friedman). The SPSS24 software was used.
At the beginning of the study, the level of spiritual well-being of patients was moderate (overall score of 59/93), however, after the implementation of spiritual care and 3 months after the completion of counseling, there was a significant increase in the existential health and total score of spiritual well-being (P Performing spiritual counseling based on the Sound Heart model, by training religious-based spiritual skills, is a good way to improve the level of spiritual well-being of patients and can be used as a community-based approach in a nursing educational-supportive system.

Quality of life is considered as the sense of well-being and life satisfaction. The healthcare professionals’ final mission is health amelioration to increase the patients’ life quality. The aim of the present study was to examine the effect of different factors on the quality of life in patients discharged from critical care units.
This cross-sectional study was performed in 325 patients admitted to critical care units of Kashan Shahid Beheshti hospital using a convenience sampling method in 2015. Data were gathered one month after patients’ discharge through a demographic questionnaire, the quality of life standardized ShortForm-36 (SF-36) questionnaire, and the post-traumatic stress disorder checklist (PCL). The obtained data were analyzed using statistical tests such as t-test and (one-way) ANOVA test.
The enrolled sample consisted of 185 (56.9%) males and 140 (43.1%) females with a mean age of 54 ± 16.15. The mean total score of life quality in the study sample was 54.32 ± 27.52 and the total score of PCL was 43.99 ± 19.94. The mean score of the life quality was lower among patients with features including over 60 years, unemployed, a long-term hospitalization, more than five children, drug abuse, using mechanical ventilation, and post-traumatic stress disorder; however, the mean score was higher in employed and highly educated people. This analysis indicated no relationship between quality of life and patient’s gender, type of critical care unit, marital status, and admission for trauma reason.
The mean score of the quality of life of patients discharged from intensive care units is low. Some of the individual and medical features such as age, drug abuse, a long-term hospitalization, using mechanical ventilation, and post-traumatic stress disorder are risk factors that decrease the quality of life. Nurses can identify and control the risk factors in intensive care units.

In intensive care units (ICU), there should be some more facilities and equipment such as ventilators, monitors, suction pumps, etc. These devices are equipped with an alarm system in their settings. Sometimes, too many alarms cause alarm fatigue among nurses and consequently would jeopardize the safety of patients. Therefore, the current study aimed at designing a tool to assess the alarm fatigue among nurses.
In the current developmental, analytic study, using reliable databases, an alarm fatigue questionnaire was designed with 32 items. The content of the tool was measured by the panel of experts and its reliability was measured by Cronbach’s alpha. Data were analyzed with SPSS software version 21.
The results showed that 9 out of 32 items of the questionnaire had low content validity index and ratio (CVI/CVR) and should be rejected; the index value of the questionnaire was 0.7 that was acceptable. The results showed that the final questionnaire was reliable (α = 0.806) with test-retest, which was repeatable.
Since the alarm fatigue can jeopardize the patients’ safety, it is required to use a reliable tool for its assessment. According to the obtained results in the current study, the present questionnaire had a relatively appropriate validity.