الهه باهنر

Emergency medical technicians (EMTs), as the front line of dealing with patients with COVID-19, are exposed to the intensification of stress caused by these conditions, and it is essential to identify related factors, such as resilience and spiritual intelligence in this context. This study was conducted to determine the relationship between perceived stress, spiritual intelligence, and resilience of EMTs during the COVID-19 pandemic.
This cross-sectional study was conducted on 108 EMTs in Shahroud in 2021. Data collection tools included the demographic checklist, Cohen’s perceived stress questionnaire, King’s spiritual intelligence questionnaire, and Conrad Davidson’s questionnaire (CD-RISC). To analyze the data, descriptive and inferential (independent t-test, Pearson correlation, and multiple regression) statistics were used.
The mean scores of perceived stress and resilience of employees were at medium and high levels, respectively. There was no significant relationship between perceived stress and spiritual intelligence (r=-0.49, P=0.24), but there was a meaningful negative correlation between perceived stress and resilience (r=-0.31, P=0.002). A positive and significant relationship was observed between perceived stress score and age and work experience.
Considering the significant relationship between perceived stress and resilience in the present study, it is suggested that the administrators provide solutions such as creating training courses to manage stress and increase resilience in EMTs.

Changing position is one of the typical nursing care in intensive care units. This study aimed to investigate the effect of body positioning on intra-abdominal pressure and endotracheal tube cuff pressure and their relationship with each other in patients undergoing mechanical ventilation

This was a before-after clinical trial study performed on 70 patients over eight months. Eligible patients were placed in one of the positions of bed angle (flat, 30, and 45 degrees) and body position sideways toward an opposite direction to the mechanical ventilator. The intra-abdominal pressure and the endotracheal tube cuff pressure were measured with each change in body position and head of the bed. Data were analyzed at a significance level of 0.05.

Mean intra-abdominal pressure was different in positions (P<0.001). The mean intra-abdominal pressure at the flat angle was (7.4±0.49) CmH2O at the lowest and 45 degrees was (11.98±0.45) CmH2O at the highest. The mean intra-abdominal pressure in the supine position was significantly lower than in other positions (P<0.001). The endotracheal cuff pressure was significantly higher in lying down on the opposite side of the ventilator than in other positions (P<0.001). There is no significant relationship between intra-abdominal pressure and endotracheal tube cuff pressure (P=0.15).

The results showed that at the flat angle and opposite direction to the mechanical ventilator, the tube cuff pressure was maximal and at an angle of 45° and the position of the opposite side of the mechanical ventilator, the intra-abdominal pressure was the highest. Although there was no significant relationship between intra-abdominal pressure and endotracheal tube cuff pressure, when lying on the opposite side of the mechanical ventilator, intra-abdominal pressure and endotracheal tube cuff pressure were abnormally high. Therefore, it is recommended to avoid the patient in this situation.

Disorders of consciousness are the most common complications after head injury. Patients with traumatic coma, due to their nature, are more likely to show impaired physiological indices. This study aimed to investigate the effect of listening to nature sounds on the level of consciousness and physiological indices in patients with traumatic coma. 60 patients with traumatic coma admitted to the Intensive Care Units (ICUs) of Shohaday-e-Haft-e-Tir Hospital in the city of Tehran, Iran, and Imam Hossein Hospital in the city of Shahroud, Iran, were randomly selected in 2017 to participate in this randomized clinical trial. They were randomly assigned to two groups of control and intervention through randomized block method. The patients in the intervention group listened to nature sounds twice a day (each time for 30 minutes) for two weeks. The level of consciousness of the patients was measured and evaluated using Glasgow Coma scale before and one and two weeks after the intervention. Also, the physiological indices of the patients were examined and recorded immediately, 30 minutes and 2 hours after the intervention on the first day of the intervention. The data were analyzed using SPSS 21 and through independent t-test, repeated measures analysis of variance, Fisher and Chi-squared tests. The number of the patients reaching complete consciousness in the intervention group was more than that in the control group (p=0.001). In the intervention group, immediately after the intervention, the mean pulse, systolic blood pressure and mean arterial pressure were lower than other times. According to these results, listening to nature sounds increased the level of consciousness of the patients, decreased the duration of coma and caused an immediate and short-term decrease in physiological indices.

Traumatic brain injury (TBI) is one of the major health problems throughout the world. The hemodynamic indices of patients with head injuries change, and these changes can worsen the level of consciousness. The purpose of this study was to determine the effect of FSRM on the level of consciousness and hemodynamic indices in patients with traumatic coma. In this randomized clinical trial, 60 patients with traumatic coma admitted to the Intensive Care Units (ICU) of  Shohaday-e Haft-e Tir in Tehran, and Imam Hossein hospital in Shahrood were randomly selected in 2017.
They were randomly assigned to two groups (control and RFM groups) using a randomized block method. Patients in both groups received routine care. Additionally, in the experimental group, RFM was performed twice a day for two weeks each day for 30 minutes. The level of consciousness of the patients was evaluated and measured using the Glasgow Coma Scale (GCS) before, one week, and two weeks after entering the study. The hemodynamic indices were measured and recorded before, immediately after, 30 minutes, and 2 hours after the intervention on the first and second days of intervention by bedside calibrated the monitor. Data were analyzed using independent t-test, chi-square, Fisher's exact, and ANOVA tests with repeated measures using SPSS(version 21). The number of patients reaching complete consciousness in the intervention group was more than the control group (p=0.002). The number of days to reach complete consciousness was lower in RFM group (p=0.001). In the intervention group, immediately after (p=0.017) and 30 minutes after intervention (p=0. 016), the systolic blood pressure decreased substantially compared to the control group. In the intervention group, immediately after the intervention, hemodynamic indices were lower compared to other measurement times. Based on the results, FSRM increased the level of consciousness of the patients and reduced the duration of coma. The results showed the immediate effect of intervention on reducing hemodynamic indices. The nurses in ICUs are recommended to use this easy and inexpensive method to perform sensory stimuli in patients with coma to improve their level of consciousness and enhance their hemodynamic parameters.