فهرست مطالب

پرستاری مراقبت ویژه - سال یازدهم شماره 1 (پیاپی 37، Feb 2018)

نشریه پرستاری مراقبت ویژه
سال یازدهم شماره 1 (پیاپی 37، Feb 2018)

  • تاریخ انتشار: 1397/01/18
  • تعداد عناوین: 7
|
  • Masoumeh Rahimi, Shohreh Kolagari *, Khadijeh Yazdi, Mohammad Aryaie Page 1
    Background
    Patients in cardiac surgery intensive care units are affected by different discomforting factors and use different strategies for their management.
    Objective
    The aim of this study was to examine the relationship of discomforting factors with coping strategies among patients hospitalized in cardiac surgery intensive care units.
    Methods
    This descriptive - correlational study was done in 2016. A convenience sample of 110 patients was drawn from the cardiac surgery intensive care unit of Amir - al - momenin heart surgery center, Kordkuy, Iran. Data were collected using a demographic questionnaire, the Discomforting Factors in Cardiac Surgery Intensive Care Unit Questionnaire, and Jalowiec Coping Scale. Pearson correlation analysis, the one - way analysis of variance, the paired - sample t - test and the Tukey’s post hoc test were used to analyze the data. Data analysis was performed via the SPSS software (v. 16.0) and at a significance level of less than 0.05.
    Results
    The mean score of discomforting factors was greater than the moderate level (74.08 ± 16.93). Participants used emotion - focused coping strategies more than problem-focused ones. Discomforting factors were inversely correlated with problem - focused strategies (r = - 0.266; P = 0.005) and directly correlated with emotion-focused strategies (r = 0.247; P = 0.009).
    Conclusions
    Patients in cardiac surgery intensive care units suffer from the negative effects of different discomforting factors and use emotion - focused coping strategies more than problem - focused strategies for the management of the factors.
    Keywords: Discomforting Factors, Coping Strategies, Cardiac Surgery Intensive Care Unit
  • Zahra Rajaeian, Negin Masoudi Alavi * Page 2
    Background
    There are many performance obstacles in intensive care units (ICU) that can waste a nurse’s time and energy. Detection and elimination of these obstacles can improve efficacy in ICUs.
    Objectives
    This study was carried out to identify the performance obstacles experienced by nurses in ICUs of selected hospitals in Kashan,Iran, 2015.
    Methods
    In this descriptive analytical cross-sectional study, all 80 nurses working in ICUs reported their performance obstacles in 240 working shifts. The research instrument had 2 parts: 1- information of nurses and their working shift; 2- nursing performance obstacles questionnaire of Gurses. The questionnaire evaluates performance obstacles in 4 dimensions of environment, task, technology, and organization. The data analyzed with the descriptive and analytical statistics including Mann-Whitney U and Krukall-Wallis tests, and multiple regression analysis using SPSS 16.
    Results
    The most common obstacles were: receiving too many phone calls from family members (75%), delay in getting medications from pharmacy (54.6%), insufficient space to sit down and do paperwork (52.9%), and disorganized unit (51.6%). In the field of technology, having to use equipment in poor condition (35%) was the most frequent obstacle. Delay in seeing new medical orders (48.3%) and inadequate information from physicians (30.4%) were other common obstacles. The nurses with less than 3 years of experience working in ICUs, those working morning shifts, and nurses who had admitted more patients reported significantly more obstacles.
    Conclusions
    Nursing performance obstacles were different. Many obstacles such as receiving too many phone calls and having to use equipment in poor condition can be managed by simple interventions such as using technology to give information to the family members. Management policies and enhancing team works are needed to reduce obstacles such as inadequate information from physicians and disorganized unit. We need further studies, to evaluate how the elimination of these obstacles can improve the nursing care in ICUs.
    Keywords: Critical Care Nursing, Intensive Care Units, Work Performance, Barrier, Perception
  • Athare Nazri Panjaki, Narges Salari, Masoum Khoshfetrat * Page 3
    Background
    Cardiopulmonary resuscitation (CPR) procedure consists of measures taken to restore the acts of the heart and the brain in a person who has lost their own consciousness. Thus, the purpose of the present study was to investigate the success rate of Cardiopulmonary Resuscitation, survival rate in patients, and their related factors in order to assist in improving effective conditions and measures within hospitals to increase the success rate of CPR.
    Methods
    This cross-sectional analytic study was conducted in 2016. To this end, a total number of 199 patients affected with cardiopulmonary arrest and undergoing the CPR procedure in the emergency wards and other hospitals units in Iran were recruited using a convenience sampling method. Then, patient information was collected through a researcher-designed checklist as well as a review of clinical records. The data were also analyzed via the SPSS.16 software. Data analysis was similarly performed using descriptive statistics and Chi-square and t-test.
    Results
    The mean age of patients was 44 years. The result of 36.7% of CPR procedures conducted was reported successful, however, only 4% of patients finally survived. In general, the findings revealed that factors such as age, gender, hospital, history of prior diseases, checked initial rhythm, work shift, time of work shift change, pre-resuscitation intubation status, and underlying cause of cardiopulmonary arrest had no effects on the success rate of CPR procedure. However, location of the occurrence of cardiopulmonary arrest (P = 0.03) and specialty of physicians in charge of resuscitation teams (P = 0.01) were among the factors affecting the success rate of CPR procedure. Furthermore, checked initial cardiac rhythm (P
    Conclusions
    Given the simplicity and teachability of the principles of basic life support (BLS), health status, and survival rate in patients can be easily and significantly promoted through the public education of the initial resuscitation measures. Moreover, according to the investigations made in this respect, post-resuscitation measures can dramatically affect the survival rate of individuals. Therefore, it is suggested to investigate post-resuscitation measures in other studies of prospective type in order to propose strategies to improve the survival rate of patients.
    Keywords: Cardiopulmonary Resuscitation, Heart Arrest, Success Rate, Survival Rate
  • Alessia Dorazio *, Antonella Dragonetti, Giorgio Campagnola, Cristina Garza, Fabrizio Bert, Simona Frigerio Page 4
    Background
    The success of non invasive ventilation depends on many factors and effective delivery requires team work. Information on the therapeutic program must be sustained by healthcare staff and family.
    Objectives
    Investigate the clinical and care factors that affect the level of patient compliance to non invasive ventilation.
    Methods
    A prospective, observational and multicentre study was conducted between November 1, 2015 and February 15, 2016 in three sub-intensive wards. A data collection tool was created with the working definition of “Patient intolerant to non invasive ventilation” and a structured interview was conducted to investigate patient experience of NIV. Statistical analysis was conducted with the STATA MP13 software.
    Results
    Coordination of patient-ventilator interaction prevents intolerance (OR = 0.68, 95% IC 0.46 - 0.98; P = 0.04). Overweight and obese patients showed a higher probability of intolerance to non invasive ventilation with respect to underweight and normal weight patients (OR = 0.53, 95% IC 0.34 - 0.82; P = 0.005). Patients with a higher probability of intolerance experienced a NRS level of 4/5 (OR = 1.76, 95% IC 1.30 - 2.41; P ≤ 0.001) while receiving continuous treatment (OR = 1.26, 95% IC 1.04 - 1.53; P = 0.019). Patients in open-space settings experienced less intolerance (4.7 SD ± 1.2) with respect to patients in single rooms (2.5 SD ± 0.9). Anxious patients developed more intolerance than calm and informed patients (OR = 7.39, 95% IC 3.19 - 17.13; P ≤ 0.001)
    Conclusions
    Compliance to non invasive ventilation depends on multiple factors, including relational aspects that affect treatment success. Attention to patient comfort, pain control, and collaboration with the caregiver appear to have the most influence on patient compliance.
    Keywords: Nurses, Patients, Noninvasive Ventilation, Intensive Care Units, Compliance, Masks
  • Ahmadali Amirifar, Abolfazl Rahimi *, Fakhrudin Faizi, Masoud Sirati Nir Page 5
    Background
    Patients hospitalized in critical care units are at risk for developing different health problems such as sleep disorders. Detection of sleep disorders is very important and needs the appropriate tools. This study was aimed to determine the psychometric properties of Richard Campbell sleep questionnaire.
    Methods
    This methodological study was conducted in the cardiac surgery intensive care unit (CICU) of Military Hospital of Tehran in 2016. A standard translation of the questionnaire was provided, and face and content validity of the questionnaire were qualitatively evaluated by the main users (patients) and experts, respectively. Reliability of the questionnaire was determined using Inter-rater reliability and internal consistency. In this study, 100 patients who met the inclusion criteria were selected using convenience sampling method. On the 2nd and 3rd day after the hospitalization, quality of their past night’s sleep was measured using the questionnaire.
    Results
    The face and content validity of the questionnaire were qualitatively at desired level. The reliability of the questionnaire through inter-rater correlation coefficient and the Cronbach’s alpha value were 0.714 (P
    Conclusions
    According to the results, Richard Campbell sleep questionnaire is a simple validated instrument that can be used by health care providers such as nurses to measure the quality of sleep in patients in cardiac surgery intensive care unit (CICU).
    Keywords: Sleep, Intensive Care Unit, Psychometrics, Richard Campbell Sleep Questionnaire
  • Yasser Moazami Goudarzi, Fataneh Ghadirian *, Amir Vahedian, Amir Pishgoo Page 6
    Background
    Angiography is the gold standard test for the diagnosis of coronary artery disease; however, more than 82% of patients have stress and anxiety before they undergo angiography, which significantly effects the diagnostic results. One of the common complications of the angiography method through the radial artery is the occurrence of arterial spasm that is seen more in patients with severe anxiety. The current researchers believe that using Benson relaxation is effective in reducing the patient’s anxiety.
    Objectives
    This study was designed to evaluate the Benson relaxation method in patients undergoing radial angiography.
    Methods
    This study was a clinical trial, which was performed on 60 candidate patients undergoing coronary angiography by radial method at Baqiyatallah Hospital during year 2017 (N = 60). The samples were randomly allocated to two groups, intervention and control. The information gathering tools were demographic questionnaire, the Beck Anxiety Inventory (BAI), and hemodynamic variables checklist. Data analysis was done with the SPPSS V16 software using Kolmogorov - Smirnov test, Mann - Whitney test, and paired - t test.
    Results
    The results showed a significant difference between the anxiety of the patients before and after the intervention in each group (P
    Conclusions
    Benson’s relaxation method can be effective in reducing anxiety in angiography candidate patients. Accordingly, it may also be effective in reducing the occurrence of radial artery spasm.
    Keywords: Anxiety, Benson Relaxation, Radial Angiography
  • Behzad Taghipour, Erika Sivarajan Froelicher, Amir Hossein Goudarzian, Yiong Huak Chan, Hamid Sharif Nia *, Ameneh Yaghoobzadeh, Ali Akbar Haghdoost Page 7
    Background
    The purpose of the study was to evaluate clinical manifestations of acute myocardial infarction as classified by age and gender.
    Methods
    This cross sectional study was conducted in a coronary care unit of a regional urban medical center in northern Iran (Amol). A total of 366 patients diagnosed with acute myocardial infarction were recruited from January to June 2013. Patient demographic information, past medical history, and current symptom data were collected.
    Results
    Multivariate logistic analyses were performed to identify risk predictors of myocardial infarction patients classified by age and gender. Risk predictors for older patients were dyspnea, OR = 1.76 (95% CI 1.01, 3.06), weakness odds ratio = 2.35 (95% CI 1.31, 4.21), nausea odds ratio = 1.83 (95% CI 1.04, 3.20), vomiting odds ratio = 2.48 (95% CI 1.34, 4.57), fatigue odds ratio=1.87 (95% CI 1.02, 3.39), belching, odds ratio = 2.13 (95% CI 1.08, 4.20), and hiccups odds ratio = 2.81 (95% CI 1.25, 6.30). Sub group analysis in older women patients identified weakness odds ratio = 3.13 (95% CI 1.11, 8.85), and belching odds ratio = 34.70 (95% CI 3.86, 312.2) as risk predictors. Among older men patients, the predominant symptoms were sweating odds ratio = 3.74 (95% CI 1.06, 13.2) and vomiting odds ratio = 2.54 (95% CI 1.10, 5.91).
    Conclusions
    This study concludes that older acute myocardial infraction patients were more likely to have non-specific symptoms. Initial assessment for acute myocardial infarction should consider the possibility of non-specific clinical manifestations, such as weakness and belching in older women, and sweating and vomiting in older men.
    Keywords: Myocardial Infarction, Age, Gender, Signs, Symptoms