roya dokoohaki

One of the most dangerous complications after endotracheal intubation or tracheostomy is tracheal stenosis.

This study aimed to determine the personal and clinical characteristics of tracheal stenosis following intubation or tracheostomy in intensive care unit patients.

This is a nested case-control study. Thirty-five patients who suffered from tracheal stenosis from March 2016 to March 2021 and had been intubated and tracheostomized in intensive care units (ICU) were selected for the case group. The control group included 105 patients intubated and tracheostomized in ICU during the same period without tracheal stenosis. A demographic and clinical characteristics questionnaire was used to collect data from the patients' medical records.

The mean length of intubation (P < 0.001), endotracheal and tracheostomy tube cuff pressure (P < 0.001), chronic obstructive pulmonary disease (COPD) (P = 0.043), intubation history (P = 0.045), and airway management (P < 0.001) showed significant differences between the case and control groups. The logistic regression model revealed that COPD (OR = 8.519, P = 0.037), intubation history (OR = 3.939, P = 0.013), length of intubation (OR = 1.118, P = 0.003), age (OR = 0.960, P = 0.030), and endotracheal and tracheostomy tube cuff pressure (OR = 1.988, P < 0.001) were associated with tracheal stenosis. The time interval between intubation/tracheostomy ranged from approximately 28 to 938 days.

Given the impact of certain care practices during hospitalization on the occurrence of tracheal stenosis, such as the mean length of intubation, endotracheal and tracheostomy tube cuff pressure, and airway management, it is recommended that standardized training on these interventions be prioritized for staff in intensive care departments. Additionally, attention must be given to specific patient characteristics, such as age, COPD, and history of intubation.

Physiological and psychological needs of intensive care unit (ICU) patients are not met due to lack of effective communication. To facilitate communication, nurses can use augmentative and alternative communication strategies (AACs). The aim of this study was to determine the effect of using these strategies on the quality of nurses’ communication with patients with endotracheal intubation in the cardiac surgery intensive care units.

 In this quasi-experimental intervention study with before-after design, 70 patients (35 at each stage) who were unable to communicate verbally after heart surgery due to intubation were recruited by the convenience sampling method, and also 10 nurses in the cardiac surgery ICU were randomly selected. In the pre-intervention stage, nurses communicated with patients using conventional methods, and after training in the post-intervention stage, using AACs. Data were analyzed using descriptive and inferential statistics through the SPSS software version 22.

The lowest content of communication in the pre- and post-intervention stages was related to emotions, the frequency of which was higher in the post-intervention stage compared to the pre-intervention stage. The most commonly used methods in the post-intervention phase were the communication board and head gesture. In both stages, communication was mostly initiated by the patient. In the post-intervention stage, the number of times the nurse started the communication increased (P<0.05). In the post-intervention phase, patients’ and nurses’ satisfaction with communication increased (P=0.0001).

Training nurses about AACs and using them for the ICU patients increase the success of communication and patients’ and nurses’ satisfaction with communication. Therefore, the use of these strategies in these wards is recommended to nurses and nursing managers.

The nurse's knowledge and skills in caring for endotracheal tube cuff pressure can lead to complications in the patient. However, few studies are available in this area. Therefore, this study aimed to determine the knowledge and practice of nurses on how to measure and control cuff pressure of patients admitted to intensive care units.

This descriptive study was performed on 151 qualified nurses working in ICU wards of Shiraz teaching hospitals in 2017. Data collection was performed using a researcher-made checklist.

21.5% of the nurses knew the normal tracheal cuff pressure and tracheostomy range. Regarding the different ways of measuring cuff pressure, 5.3% referred to the minimum leakage method, 86.7% to the manual method, 74.7% to the manometer, and no reference was made to the obstruction method. 60.7% used the manual method to measure cuff pressure, and only 39.3% used a manometer. 3.3% did not know the time interval of cuff pressure measurement. 40% in each shift, and 56.7% stated every 24 hours as the appropriate time to control it.

The results of the present study showed that the performance of nurses concerning the ways of measuring cuff pressure is appropriate. However, the nurses' knowledge in this study is limited about the normal range of endotracheal tube cuff pressure and the complications caused by the abnormal low cuff range.

The global prevalence of hypertension is one billion persons resulting in about 7.1 million deaths per year. In Iran, no statics of hypertension is available, but it has been reported that 40% of deaths are caused by cardiovascular diseases. Measuring blood pressure is one of the basic principles of medical examinations; however, the quality of the scientific standards of its technique is not highly observed.. The present study aimed to evaluate the frequency of errors of measuring blood pressure among B.Sc. nurses working at in government hospitals of Shiraz, Iran.. This descriptive-analytical, cross-sectional study was conducted on 250 nurses selected from various wards. The study data were collected using the standard check list of blood pressure measurement, technique of American Heart Association (AHA guideline), and a questionnaire containing questions regarding knowledge about blood pressure measurement skills.. This study showed that 54.0% and 78.0% of the participants obtained moderate scores (50 - 74.99) in the theoretical and practical tests, respectively. The results of Pearson’s correlation coefficient demonstrated no significant relationship between the scores of theory and practice (P > 0.05). Most of the errors in measuring blood pressure in this research consisted of not measuring blood pressure at two stages, not observing its preparations and the proper time interval between the two stages, and not observing the measuring arrangements according to the checklist.. Considering the participants’ theory and practice scores, it was concluded that evaluation of blood pressure measurement, which is an important basis in diagnosis and treatment, should be considered as an educational priority of health teams..

One of the most important functions of nurses, which require preparation and powerful scientific background, skill in decision making and careful attention to drug laws is administration of the drugs to the patients. The aim of the present study was to evaluate the knowldege and practice of the student nurses about drugs by OSCE method at the end of the third year of their education. In this cross- sectional study, 48 student nurses (45 females and 3 males), with a mean age of 21 years took part in a theoretical exam and 36 of them participated also in a practical exam. A demographic questionnaire including personal details, Over Time working (OT), the usage pharmacological sources and the level of encountering different pharmacological methods was used to collect data. Then, a theoretical exam, covering the whole drugs the subjects had learnt during 6 semesters, was taken and after that, 9 routes of drug administration (Suppository, NG tube, PO, SQ, IV, IM, ID, Topical and inhalation) were examined by OSCE Method in 2 consecutive days. The scores were given based on the drug administration check list. The findings showed that encountering students with different routes of drug administration were Topical =93.7%, Inhalation=31.25%, SUPP =43.75%, NG= 98%, ID=6.26%, SQ= 98%, IV = 100%, PO=100% and IM=100%. The mean score of theoretical and practical exam were 49.02 and 63.8, respectively. A correlation of 0.32 was obtained between scores of theoretical and practical exam Since drugs administration requires both pharmacological information and practical skills, special attention should be paid to the theoretical and practical education of student nurses.