Abstract
Aim. This study aimed to compare physicians’ and nurses' perceptions of futile care.
Background. Futile medical care is the provision of medical care or treatment to a patient when there is no reasonable hope or chance of a benefit. Determination of perceptions of futility is crucial to reduction of situations leading to futility and end-of-life decision-makings.
Method. The present study is a descriptive-comparative cross-sectional study in which 114 nurses and 57 physicians working in intensive care units of selective teaching hospitals of Shiraz University of Medical Sciences were recruited by convenience sampling method based on the inclusion criteria. The data collection instrument was a researcher-made questionnaire of futile care perception whose validity and reliability was assessed by experts, test-retest and Cronbach's Alpha methods. The Data were analyzed using descriptive and analytical statistics in SPSS software version 16.
Findings. The mean score of physicians’ and nurses’ perceptions of futile care was 77.29±13.79. The mean score of nurses’ perception was 78.46±14.4, turned out to be higher than that of physicians (74.91±12.3). The highest level of consistency between the two groups was related to the item "ineffective communication" and “disregarding the members in the decision-making process by the ICU attending physician”. As for "stressfulness of futile medical care", nurses experienced higher stress levels and there was a statistically significant difference between the two groups in this regard.
Conclusion. The agreement on the most important factors affecting the perception of futility indicates consistency between physicians’ and nurses’ perceptions of futile care. The high perception scores in both groups, and the stressful nature of futile medical care require necessary training mechanisms needed to deal with such situations.

Abstract
Aim. The purpose of this study was to compare the effect of clinically-indicated replacement and routine replacement of peripheral venous catheters on catheter-related complications and satisfaction in patients undergoing cardiac surgery.
Background. The insertion of peripheral vein catheter is one of the most commonly used minimally invasive measures in hospitalized patients. Catheters can be maintained until they are working well.
Methods. A randomized controlled clinical trial was conducted in intensive care units of Rajaie Cardiovascular Medical and Research Center in 2017. After ethical Approval, 104 Patients were randomly allocated to either clinically-indicated replacement or routine replacement of peripheral venous catheters (every 96 hours) (52 Patients in each group). Data collection tools included demographic form, catheter placement data sheet and a researcher-made patients’ satisfaction questionnaire. Data were analyzed in SPSS using descriptive and inferential statistics.
Findings. There were no statistically significant difference in terms of the incidence of complications between the groups. Also, there were no statistically significant difference between the scores of satisfaction of the patients of the control and experimental group.
Conclusion. No evidence was found of superiority of routine replacement of peripheral venous catheters over clinically-indicated replacement. Caregivers may consider changing the protocol of catheter replacement from routine replacement to clinically-indicated replacement. This would protects patients from the unnecessary pain of routine replacement in the absence of clinical indications.

Abstract
Aim. The present study was conducted to compare the effect of e-learning and lecture education on critical care nurses' performance about cardiovascular medication.
Background. The present time is known as the technology development time, and the educational institutions have undergone major changes. The complex learning process should not be limited to classroom and the use of  e-learning can help to overcome some barriers of traditional methods of education in nursing.
Method. This quasi-experimental study was conducted on 70 nurses working in intensive care units of social security hospitals in Isfahan province in 2017. They were recruited to the study and allocated randomly   to either lecture (n=35) or e-learning (n=35) group. Nurses’ performance was evaluated by the questionnaire of cardiovascular medication before and after the interventions, and the effect of two methods of e-learning and lecture training on nurses’ performance scores was compared.
Findings. Both lecture and e-learning methods had a statistically significant effect on nurses' medication performance (P≤0.0001). However, no statistical significant difference was observed between the two groups in terms of changes in nurses' medication performance.
Conclusion. E-learning can be a substitute for lecture education in-service-training of pharmacology topics for critical care nurses.

Abstract
Aim. This study was conducted to evaluate effect of bedside teaching on critical care nurses' performance in airway suctioning
Background. One of the most effective measures in patients undergoing mechanical ventilation is suctioning the trachea to prevent the accumulation of potentially infectious pulmonary secretions and to clear the airway which is carried out by critical care nurses. If suctioning cannot be correctly performed, some complications may occur.
Method. This was a quasi-experimental study in which the study sample consisted of 54 critical care nurses working in Rajaie Cardiovascular Medical and Research Center, Tehran, Iran. The nurses were recruited through convenience sampling based on inclusion criteria. Critical care nurses’ performance in airway suctioning were evaluated before and two weeks after intervention using a checklist. The intervention included bedside teaching of suction procedure.
Findings. Two weeks after intervention, the mean score of performance in airway suctioning increased significantly (P≤0.0001). Hand washing or using hand was recorded only for 16 nurses before intervention and for 35 nurses after intervention. Maintaining catheter sterility during suctioning was considered by 28 nurses before intervention, and by 40 nurses after intervention. Correct procedure documentation and recording secretion characteristics before and after intervention were carried out by 13 and 34 nurses, respectively. While activating suction during bringing the catheter out of endotracheal tube was done by 31 nurses before intervention, after intervention 41 nurses did so.
Conclusion. Bedside teaching of correct airway suctioning for critical care nurses enhance their performance in this procedure.

Abstract
Aim. The purpose of this study was to review the patient– and family-centered care studies in coronary artery bypass graft surgery.
Background. Nowadays, the length of hospital stay after cardiac surgery is reduced, and the most of the patients recover at home with their families without usual nursing and medical care. It is necessary to provide the care based on the same needs.
Methods. This is a comprehensive review of literature published between 1990-2018 about patient- and family-centered care interventions and patient/family important outcomes in adult ICUs that was conducted through searching out databases and search engines Medline, Ovid, Science Direct, PubMed and Google scholar, including English and Persian papers. In total, 73 English papers and 46 Persian papers were found, out of which 25 papers were included in this review.
Findings. Engaging families in patient care can profoundly influence clinical decision making and patient outcomes. Yet in many hospitals and health care systems, outdated visiting policies separate families and other loved ones during hospital stays.
Conclusion. Patient– and family-centered care is associated with better clinical outcomes. The clinical benefits that have been identified through a family partnership approach in these settings include decreased mortality, increased satisfaction, improved adherence to treatment regimens, and decreased readmission rates. Although high-quality interventional studies are needed to further evaluate the effectiveness of patient- and family-centered care in coronary artery bypass surgery, it is obvious this movement in healthcare is making a huge impact on family satisfaction and patient outcomes.

Abstract
Aim. This study aimed to examine the effects of preoperative preparation of patients and family caregivers on outcomes after coronary artery bypass graft surgery (CABG).
Background. Preoperative preparation can improve patients’ experience of surgery and hospitalization. However, there is limited data about how preoperative preparation affects postoperative outcomes following CABG.
Method. This non-randomized clinical trial was conducted on ninety pairs of patient/ caregiver in the time period from July to November 2018. The participants were purposively selected and non-randomly allocated to either control or experimental group. The intervention was performed one day after admission and the day before CABG in the form of an educational video, an intensive care unit tour, and an educational booklet. In both groups, on the third day after surgery, patients' delirium was assessed in the ICU and family caregivers were asked to complete a family satisfaction questionnaire. Patients and their family caregivers in both groups completed a hospital anxiety and depression questionnaire (HADS) on the first and seventh days after surgery and before discharge. Data were analyzed in SPSS version 16.0 using descriptive and inferential statistics. 
Findings. After intervention, the mean score of patients’ anxiety and depression in the intervention group was significantly less than the control group (P=0.03). After intervention, the mean score of anxiety and depression among family caregivers in the control and experimental groups were not significantly different (P=0.11). Family caregivers’ satisfaction of experimental group was significantly higher than the control group in both healthcare providers’ performance dimension (P=0.01) and comfort dimension (P=0.027). Moreover, the groups did not significantly differ from each other regarding delirium incidence (P=0.6) and length of stay in the intensive care unit (P=0.21).
Conclusion. Considering that the preparation of the patient and family caregiver on the day before CABG can reduce patients' anxiety and depression and increase the satisfaction of the family caregiver, it is recommended to use this intervention for patients and family caregivers before CABG.

Abstract
Aim. This review study aimed to investigate the role of thirst in the development of delirium in patients admitted to intensive care units.
Background. Delirium is a common clinical syndrome in patients admitted to intensive care units, affecting approximately one-third of these patients. Delirium is a multidimensional phenomenon. One of the most important and controversial factors in the occurrence of delirium is the phenomenon of thirst.
Method. This study was conducted by searching out Persian and English databases of Magiran, SID, Web of Science, Science Direct, PubMed, Scopus, without publication year consideration and using the keywords "thirst", "dehydration", "hyperosmolarity" and "delirium". Of 55 articles retrieved, 17 articles were reviewed by the research team among, and finally, after complying with the inclusion criteria and evaluating the quality of articles, 6 articles were included in the study.
Findings. The findings of the present study showed that tolerating the thirst for more than 24 hours is a risk factor for delirium. The role of fluid deficiency in the pathogenesis of delirium is not fully understood, but factors such as tissue hypoperfusion (especially in the brain and kidneys), increased concentrations of drugs or their metabolites in reduced intravascular volumes, and decreased renal function in excretion and/or drug metabolism are possible causes for development of delirium.
Conclusion. There is a lack of studies in this area and due to the importance of delirium and thirst in patients in the intensive care units or the elderly patients, more studies should be conducted in this area. All these factors calls for more attention and studies in this area.

Abstract
Aim. This review study explores cardiovascular changes in preterm neonates during the transition from intrauterine to extrauterine life, respective challenges, and nursing care during this period.
Background. The transition from intrauterine to extrauterine life requires well-regulated and complex biochemical, physiological, and anatomical changes to ensure the survival of the neonate. Compared with term neonate, transition for a preterm neonate occurs over a longer period of time. Careful assessment and timely intervention by health care providers is pivotal to help the preterm neonate adapt to extrauterine life.
Method. This review study was conducted through systematic and focused searching out for literature published between 2000 and 2020 in database/ search engines Google Scholar, Web of Science, PubMed, Scopus by the selected keywords Transition, Extrauterine life, Preterm neonate, Nursing care and their Persian equivalents.
Findings. Twenty six English articles and two books about neonate related to the topics of transition to neonatal extrauterine life, challenges and respective nursing care were found. Findings were organized into five thematic category: immature myocardium, blood circulation, patent ductus arteriosus (PDA), hypotension and hemodynamic instability.
Conclusion. Comprehensive hemodynamic monitoring and skillful clinical evaluation, and wise judgment are recommended for better management of complex transition phenomena in preterm neonates. Management protocols should be developed for transition period in preterm neonates.

Abstract
Aim. This study was conducted to examine the effect of mentalization-based therapy and emotion-regulated therapy based on the Gross process model on psychological well-being and quality of work-life of nurses in intensive care units.
Background. Improving nurses' well-being and satisfaction with their quality of work-life improves the nurse-patient relationship and hospitals' performance from an organizational point of view. It is necessary to provide psychological therapeutic interventions to this crucial group of health care providers.
Method. This study was an experimental  study (pre-test post-test with control group) in which 45 nurses working in intensive care units of selected Tehran hospitals, Iran, were selected by the convenience sampling method, and assigned to two intervention groups and one control group (15 nurses in each group). Reef's short-term psychological well-being and Walton's 32-item quality of work-life were used to measure dependent variables of the study. Then, mentalization-based therapy group received intervention in 8 sessions of 90 minutes as one session per week; and the treatment group based on emotion regulated therapy based on the Gross process model received the intervention in 8 sessions of 90 minutes, one session per week based on the protocol. No intervention was implemented for the control group. Data were analyzed using descriptive and inferential statistics in SPSS software.
Findings. Before the intervention, there were the highest scores for quality of work-life in the control group. At the end of the study and after the intervention, the scores of quality of work-life increased in all three groups, and no statistical significant difference was found between the groups. Before the intervention, the highest scores for psychological well-being was observed in the mentalization-based therapy group. (85.86±6.56), and after the intervention, although the psychological well-being scores of both interventions groups were higher than that of control group, but this diferrence was not statistically significant.
Conclusion. Based on the findings of this study, it seems that training sessions of mentalization-based therapy and emotion-regulated therapy based on the Gross process model improve the quality of work-life in nurses working in intensive care units, but the improvement was not statistically significant.

Abstract
Aim. This study was conducted to compare the prevalence of neck pain and disability among nurses in intensive care and general wards.
Background. Nursing is known as one of the ten occupations that are associated with musculoskeletal complications. In has been reported that neck and shoulder disorder are more common among nurses with high physical workload than those with low physical workload. So far, few studies have been performed on neck problems in nurses working at intensive care unit.
Method. In this cross-sectional descriptive-comparative study, 40 nurses from intensive care units and 40 nurses from general wards of Rasool Akram hospital, Tehran, Iran, were selected by convenience sampling method. Data collection in both groups was done through completing a checklist of demographic characteristics, Neck Disability Index (NDI) and Neck Pain and Disability Scale (NDPS) questionnaires by participants. The data was analyzed in SPSS version 22 using descriptive and inferential statistics.
Findings. The prevalence of neck pain and disability (measured by NDI and NPDS) in all nurses was 77.5 percent and 60 percent, respectively; 90 percent and 70 percent in nurses working at the intensive care units, and 65 percent and 50 percent in nurses working at general wards. The difference in scores measured by NDI was statistically significant between nurses working at the intensive care units and those working at general wards (P=0.014).
Conclusion. The prevalence of neck pain was significantly high in nurses, which could be due to their high workload that requires appropriate preventive measures and reduction of their physical workload.

Abstract
Aim. The aim of this study was to determine the attitudes of intensive care unit nurses towards communicating with unconscious or conscious intubated patients unable to speak.
Background. Communication is one of the most important tools in patient care and is more important in intensive care units because many patients are unable to communicate verbally due to illness or treatment.
Methods. This descriptive cross-sectional study was conducted on 174 nurses working in intensive care units. They were selected by convenience sampling method. Data were collected by a researcher-made questionnaire through self-report. This questionnaire had two sections of views on communication with unconscious or conscious intubated patients unable to talk and factors related to non-communication with these patients which was completed either in paper or electronic form. The data were analyzed in SPSS version 26 using descriptive statistics and Pearson correlation.
Findings. The results showed that the majority of the studied units (94.3 percent) had a positive attitude towards communicating with patients with speech disabilities admitted to intensive care units. It was also found that large number of patients, nurse's reluctance to work in intensive care units, loading of unprofessional tasks, psychological fatigue, and no mastery in communicative skills are more associated with communicating with this group of patients.
Conclusion. According to the positive attitude of nurses towards communicating with unconscious or conscious intubated patients unable to speak, this positive attitude can be used to improve nurses' communication performance. In addition, it is necessary to improve the quality and quantity of communication with patients with speech problems through management measures to control some factors related to communicating with patients with speech impediments.

Abstract
Aim. This study aimed to compare the effect of Adaptive Support Ventilation (ASV) and Synchronized Intermittent Mandatory Ventilation-Pressure Support (SIMV-PS) modes on consequence of weaning off patients from mechanical ventilator after coronary artery bypass surgery
Background. The ventilation mode used for respiratory support in patients after coronary artery bypass graft surgery is very important. In addition to avoiding pressure on patient's sternotomy incision, the ventilation mode should also provide the possibility of rapid weaning of patient to avoid complications caused by long-term ventilation.
Method. In a semi-experimental study, 26 patients were ventilated with ASV as the experimental group and 26 patients were ventilated with SIMV-PS mode as the control group after coronary artery bypass graft surgery in Rajaie Cardiovascular Medical and Research Center, Tehran, Iran. Mechanical ventilation time and endotracheal tube removal time, hemodynamic variables, and arterial blood gas analysis were compared between the two groups. Data were analyzed using an independent t-test, repeated measures ANOVA and chi-square.
Findings. Out of 52 patients, 36 (69.2 percent) were male and 16 (30.8 percent) were female. The mean time for the endotracheal tube removal was 89.42±33.83 minutes in the experimental group and 101.53±44.91 minutes in control group, which did not have a statistically significant difference (p=0.843). The mean duration of mechanical ventilation of patients in the experimental group was 483.84±158.153 minutes and in the control group, it was 541.92±257.81 minutes, which were not statistically different (p=0.332).
Conclusion. The use of ASV mode for mechanical ventilation after coronary artery bypass graft did not affect reducing the duration of mechanical ventilation and the time of endotracheal tube removal compared to SIMV-PS mode. Therefore, the use of ASV mode for respiratory support of patients undergoing coronary artery bypass surgery should be considered according to the patient's condition and the nurses' expertise.

Abstract
Aim. This paper aims to investigate barriers and opportunities of the virtual visiting in intensive care unit during Covid-19 pandemic.
Background. Face-to-face visits of hospitalized patients in intensive care units reduce separation anxiety and stress caused by hospitalization, as well as increase the feeling of comfort and safety in patients. In addition, it is the key to patient/family-centered care. However, the Covid-19 pandemic and its related restrictions ruled out the possibility of using the family's potential and providing patient/family-centered care. Virtual visiting has been proposed as a solution to remove the family's distance from the patient.
Method. This review was conducted by searching out databases, Web of Science, Scopus, PubMed, Magiran, SID and Cochrane with the keywords, Covid-19, Video calls, Family-patient center care, Intensive care unit, and Virtual visiting without time limitation. The inclusion criteria were the publication of the article in Persian or English language and the availability of the full text of the articles. In total, 45 articles were found, most of which focused on virtual appointments and virtual patient visits by physicians. After removing irrelevant papers, and the cases without full text, 29 articles were evaluated in terms of quality. Finally, 10 articles were evaluated in terms of subject, and the purpose related to the present study.
Findings. During Covid-91 pandemic, virtual visits were done in intensive care units in most medical centers using cell phones and tablets through social networks facilities. In all cases, families and health care providers were satisfied with this communication method, but they considered it was not a suitable substitute for face-to-face meetings. They believed that this method combined with face-to-face meetings would be more effective. Lack of regular and systematic planning, ambiguities in the duties of health care providers in the field of holding virtual visiting, lack of access to the internet at a suitable speed, and the complexity of working with smartphones for some families, were barriers of this method.
Conclusion. Virtual visiting provides a form of presence for families who are far away from their patients. Via this method, not only one but also all the family members can visit the patient. Although this method did not affect the stress and anxiety of the family and patients, but it was able to create a positive experience for them during hospitalization in intensive care units. Moreover, by involving the family in treatment process and informing them opens the ways to reach the patient/family-centered care in intensive care units.

Method. This literature review was conducted through a systematic and targeted search of articles and texts published from 2008 to 2024 in PubMed/, Web of Science, Google Scholar, and Scopus using the keywords Patent ductus arteriosus, Infant, Nursing care, Treatment, and their Persian equivalents.

Findings. Twelve articles and one book were found and the findings were organized as definition and pathophysiology of patent ductus arteriosus, diagnoses. treatment options, and nursing care.
Conclusion. The transition of the fetus from the womb to extrauterine life is one of the dynamic and vital adaptations in the life of neonates, especially premature neonates. With comprehensive monitoring and skillful clinical assessment, patent ductus arteriosus in neonates can be better managed.