نشریه پرستاری مراقبت ویژه
سال چهاردهم شماره 1 (پیاپی 49، بهار 1400)

A well-functioning vascular access is a mainstay and vital to perform an efficient hemodialysis in hemodialysis patients. Vascular access includes Arterio-Venous Fistula (AVF) and temporary or permanent central venous catheter. Dialysis adequacy is an essential element in the management of chronic Hemodialysis (HD) treatment as the adequacy of the dose has a profound effect on the patientchr('39')s morbidity and mortality. Various factors affect the adequacy of dialysis including vascular access. The aim of present study was to investigate the relationship between vascular access type and dialysis adequacy in HM patients.

All patients undergoing HM referring to the dialysis ward of Tohid Hospital in Sanandaj city were selected by census method. Patients were divided into two groups according to vascular access type (AVF or permanent CVC). The Kt/V was used as the gold standard for measuring the adequacy of dialysis. Laboratory parameters including hemoglobin, phosphorus, albumin and parathyroid hormone were recorded. Finally, socio-demographic information and treatment characteristics were collected.

The patients were divided into two groups: arterial-venous fistula (n=74) and permanent catheter (n=69). The mean KT/V in patients was 1.32±0.28. There was no significant difference in dialysis adequacy between the two groups. Also, the laboratory parameters in the two groups were not significantly different.

Findings revealed that dialysis adequacy in patients with permanent vascular access (arteriovenous fistula or permanent central venous catheter ) is highly efficient. Therefore, these methods can be used in their indications. In terms of improving laboratory tests, further studies are needed to clarify this issue.

The mission of health systems is to ensure community health by providing optimal health services. One of the methods to evaluate health services is patient satisfaction. On the other hands, unconscious patients have unable to decide and assess their treatment processes in intensive care units ( ICU); Therefore, satisfaction assessment should be measure just through a family of admitted patients, the study aim is to determine the family satisfaction of ICU admitted patients  the in educational and medical centers of Iran University of Medical Sciences in 2019.

This descriptive cross-sectional study was performed on 385 family members of ICU admitted patients, who were selected by consecutive sampling method. Data collection tool was FS-ICU 24 questionnaire.

According to the results of this study, the average score of satisfaction of all family members was 54.22 and higher than the average score (50). Among the dimensions of satisfaction, the highest mean score was related to the dimension of care measures with an average of 55.56 and the lowest mean was related to the dimension of participation in decision making with an average of 50.17.

The overall family satisfaction of ICU admitted patients was lower than studies in other countries. In addition, despite the importance of the family members involvement in patient-related decisions, the level of satisfaction was far below all dimensions of satisfaction. Such a finding highlights the need for health care providers to pay more attention to the needs of family members of ICU admitted patients, to involve them in the decision-making process and to promote communication between medical staff and family members.

Nurses working in intensive cares unit are regularly "affected" by stressors in the workplace, professional self-concept is part of the care structure and affects the performance of the nurse and helps nurses in various roles to deal with Overcoming stressful working conditions to have better care of patients. Therefore, the present study was conducted to determine the relationship between professional self-concept and Occupational stress of nurses working in intensive care units in teaching hospitals in Tehran.

This study is a descriptive-correlational study. In 2020, it was performed on 126 nurses working in the intensive care unit in Tehran. Data collection tools included a demographic questionnaire, the Nurse Self-Concept Questionnaire (NSCQ) and the standardized Job Stress Scale.

Results showed that the total mean score of professional self-concept in pediatric nurses was 216.56±35.92 and the total mean score of occupational stress in nurses Working in Intensive Care Units was 39.09±4.79.The highest score were respectively related to dimensions of care (39.42±6.28) and communication (39.06±5.89) and the mean scores in other dimensions were also moderate. Moreover, there was a negative linear correlation between occupational stress and professional self-concept.

According to the results of the present study, Occupational stress decreases with increasing the professional self-concept of nurses in intensive care units. Therefore, it requires the attention of as many officials as possible in this regard.

Admission in intensive care units is a crisis for the patient and family and the critical condition of patients admitted to intensive care units or the possibility of their death in these wards necessitates the need for their families’ visits. This study aimed to investigate the effect of scheduled visitation from the perspective of nurses and families of patients admitted to the general intensive care unit.

The present study was conducted using a quasi-experimental design in 2019. The participants were 60 nurses working in adult intensive care units and 197 families of patients admitted to the ICU who were selected by convenience sampling. The instruments used to collect the data were a demographic information registration form to record the nurses’ demographic data, the Beliefs and Attitudes Visitation Questionnaire (BAVIQ) to assess the nurseschr('39') beliefs, and the Attitudes Evaluation Questionnaire to survey the families of patients admitted to the intensive care unit. In this study, patientschr('39') families were asked to be present at the patientchr('39')s bedside for 6 days and perform the trained procedures. The patientschr('39') families completed the Attitudes Evaluation Questionnaire before and after the intervention. The nurses also completed the BAVIQ questionnaire before and after the research project.

The results showed that 68.3% of the nurses were female, 48.3% were in the age group of 30-45 years, 56.7% were married, 45% of them were working contractually, and 81.7% were working in rotating shifts. Besides, the results of the paired samples t-test showed that the nurseschr('39') views about visitation were significantly different before and after the intervention (p<0.001).However, the Patientschr('39') family attitudes had not significantly different views toward scheduled visitation before and after the intervention (Pvalue=0.375).

The present study suggested that the nurses had positive views about the presence of families of patients admitted to the intensive care unit and there is a conducive context for the presence of the patients chr('39')families. However, the patientschr('39') families reported a negative view. Accordingly, some measures must be taken to prepare the families emotionally with the training given to them and make them familiar with the positive effects of attending their patientchr('39')s bedside.

Intensive care unit (ICU) is a complex and dynamic unit with multiple interventions to recover critical and unstable patients. Nurseschr('39') perception of the components of the nursing professional practice environment (NPPE) in these units can be effective in retaining qualified and expert nurses.The aim of the study was to investigate the nurseschr('39') perception of the NPPE in ICU hospitals affiliated with the Shiraz University of Medical Sciences

The present study is descriptive cross-sectional, multi-centered study was conducted in 20 ICUs of five teaching hospitals affiliated with the Shiraz University of Medical Sciences between 2018 to 2019. The research population consisted of 350 nurses working in various adult ICUs who were selected by the stratified random sampling with a proportional allocation. Data were collected using the Nursing Professional Performance Inventory (NPPEI) designed and validated in Iran.

Results :

The mean score for the NPPEI was 38. 2±2. 5. “Effective leadership” and “Policy Transparency “domains obtained the highest (45.5±3.9) and lowest (31.2±3.1) scores. There was not significantly correlated between the demographic data and the NPPEI score (p>0.05).

Conclusion:

 The results of the present study showed that nurseschr('39') perception of the NPPE in ICU is relatively favorable. Therefore, considering the importance of workplace attributes in attracting and retaining qualified nurses, nursing managers and health policy-makers should attempt for frequent monitoring and promotion of the critical wards.

Mechanical ventilation is the most basic supportive care in patients admitted to the intensive care units. Some factors such as increase in airway resistance due to bronchospasm, may affect ventilation, that measured by different methods. The aim of this study was to compare the diagnosis of bronchospasm based on the calculation of airway resistance using ventilator data and clinical examination in patients admitted to the intensive care unit.

This descriptive cross-sectional study was performed on 180 patients, who admitted in the intensive care units of Ahvaz teaching hospitals and undervent mechanical ventilation. Patients were included in the study according to the inclusion criteria and were evaluated daily in terms of increasing airway resistance in two ways: clinical examination (presence of wheezing or Ronchi) and ventilator data (calculation of airway resistance). Data was recorded in a researcher-made checklist.

Among 180 patients enrolled in the study, the mean age was 57.77±18.95 years. There was a significant relationship between diabetes, asthma, hypertension and hyperlipidemia with an increase in airway resistance (P<0.05). Airway resistance was higher in women than men (P=0.004). There was a statistically significant difference between airway resistance detection through clinical examination and airway resistance detection based on ventilator data (p <0.001).

The results showed that detecting increased airway resistance through ventilator data was more sensitive than physical examination, So the use of it, in patient management is recommended.

Inadequate oral care in intubated patients leads to decreased salivation, dry mouth, dental plaque, gingivitis and accumulation of pathogenic bacteria in the mouth and throat and aspiration of the contents of the mouth into the trachea and subsequently causes ventilator associated pneumonia. Two mechanical and chemical methods have been recommended for oral care, and contradictory results have been reported regarding its effects on ventilator associated pneumonia. Therefore, the aim of this study was to compare the effect of comprehensive oral care program and combination of toothbrush and mouthwash with 0.2% chlorhexidine on the incidence of ventilator-associated pneumonia in intubated patients under mechanical ventilation.

Materials: 

The current study is a clinical trial that was performed in the intensive care unit of Khatam Al-Anbia Hospital in Zahedan in 2020. 90 ventilated patients who met the inclusion criteria were selected and then randomly allocated by permutation block into three groups of comprehensive oral care program, combined toothbrush program and chlorhexidine and control groups. Data collection tools were demographic information form, Modified Clinical Pulmonary Infection Score (MCPIS) and Beck Oral Assessment Scale (BOAS).

The incidence of ventilator-associated pneumonia was lower in the intervention groups than in the control group, But there was no significant difference in the incidence of pneumonia between the three groups. (P=0.168)

The incidence of ventilator-associated pneumonia in the use of a comprehensive oral care program, a combined program of toothbrush and chlorhexidine 0.2% and the control group were not different from each other and in fact these methods were not superior to each other in this regard. However, considering that clinically the incidence of pneumonia was lower in the intervention groups than in the control group, it indicates that a special care program or instruction should be used, while training health care workers based on specific instructions in the oral care is recommended.