Aim. The aim of this study was to determine prevalence and causes of fever in hospitalized

patients at intensive care unit (ICU) and its associations with the demographic characteristics .

Background. Fever is a common problem. About 70% of hospitalized patients in the ICU have

fever, which can lead to increased mortality rate in them.

Method. This descriptive analytical study was conducted on 110 patients in the Intensive Care

Units of Sanandaj educational hospitals who had no fever on arrival in the ICU and had a higher

temperature than the 38.3°C, after 24 hours. Data were collected from March to July 2008 by a

standard questionnaire which completed and coded by the researcher. The data were analyzed by

using SPSS software.

Finding. The findings showed that the infectious causes of fever were respectively infections

caused by catheter (38.02%), ventilator associated pneumonia (34.5%) and complications caused

by wounds infections (14.5%) also the majority of non-infectious causes of fever were due to

aspiration pneumonia (29.1%). The Chi-square test showed statistically significant correlations

of age (P<0.01), duration of hospitalization (P<0.05) and the Glasgow Coma Scale (GCS) of

patients (P <0.01) with fever.

Conclusion: Fever incidence in the ICU patients is a relatively common complication. In this

study, the frequency of this complication is similar or even lower than studies done in other areas

and indicates that, despite of lower health care facilities in the study area, the principles of infection

control and patient care has been considered.

Abstract

Aim. The aim of this study was to evaluate complications of intravenous Streptokinase therapy in acute myocardial infarction patients admitted to the cardiac intensive care unit.

Background. Myocardial infarction is a common disease and the use of thrombolytic agents such as Streptokinase reduces its mortality, but there are some complications associated with streptokinase.

Method. In this descriptive stud y 120, patients treated with streptokinase were evaluated in terms of complications of the drug. A checklist of Streptokinase complications was used to collect the data. The findings were presented in the form of descriptive and inferential statistics.

Findings. According to the finding s, %33.3 of patients had cardiovascular complications, %23.9 developed allergic symptoms, and %17.5 suffered blood complications.

Conclusion. The incidence of cardiac complications was the highest among patients. It is recommended to train nurses to avoid possible complications.

Abstract

Aim. The aim of this study was to determine the current quality of triage in intensive care units for patients admitted to hospital emergency departments in ShahidBeheshti University of Medical Sciences in 2012.

Background. Accurate and rapid patient triage in emergency departments is the key to a successful performance. The study and understanding of the current condition and evaluation  of the  educational needs of triage nurses are highly important.

Method. This study is a retrospective descriptive study in which the data were gathered via in a list of ESI  triage forms. To determine the content validity of data collection tools was used. In this study, the reliability of the test listed under triage nurse was both between observers and reliability with Intraclass Correlation Coefficient (ICC) : 0.857 was specified.

Findings. In this study,23% of the case were undertriage and 11.7% were overtriage.The most of undertriage cases was level 3 based on Emergency Severity Index  (ESI) system. There is a direct correlation between the mortality and hospitalization in the Intensive Care Unit (ICU) and undertriage.

Conclusion. There was no statistically significant difference between proper triage and undertriage cases in  mean length of hospital stay, duration of hospitalization and emergency department waiting time for the first visit of  the emergency physician.

Abstract

Aim.The aim of this study is to review the visiting policies, strategies and potential challenges and their different dimensions in ICUs in different societies.

Background. Considering the special needs of patients and their families is one of the essential elements of care in the intensive care units (ICU).

Method.This is a comprehensive review of the studies on different policies about visiting patients in intensive care units, based on  the scientific database. 

Findings.The studies show that despite awareness of the role of family care, visiting hours and related policies in ICUs are still limited due to the medical team concerns. While existing research and evidence do not support these concerns. They show open visiting hours have more benefits for patients and families, however visiting hours   in some societies are still  restricted.

Conclusion. The integration of theory, practice and the use of research findings in improving the quality of care of critically ill patients and their families in intensive care units  is an important part of care. In practice, it is necessary to change the beliefs and attitudes of nurses in intensive care units. Further studies on opening visiting hours in intensive care units and its effect on treatment process is one of the major issues.

Abstract

Aim.The aim of this study was a review on common pain assessment tools which are used in critical care units.

Background. Pain is an unpleasant physiological and psychological feeling and a complex phenomenon which is common among patients in critical care units. Nowadays, the importance of pain is to the extent that the American Pain Association named it as the fifth vital sign. Pain relief is an important issue to improve patient outcomes in the intensive care units. Accordingly, nurses must be sensitive in precise pain assessment.

Method. In this review article, six pain assessment tools were selected based on the keywords "pain", "pain relief", and "pain assessment tools" from the databases Ovid, PubMed, Cochran, CINHAL, Science Direct, Scopus, and Google Scholar. 

Findings.Among articles on pain assessment tools, 40 articles were selected. There are six commonpain assessment toolsused in critical care units includingCritical Pain Observation Tool (CPOT),Behavioral PainScale(BPS), behavioralpain assessmenttool(FLACC), Non-VerbalPainScale)NVPS), Pain Assessment and Intervention Notation (PAIN) algorithm and Nonverbal Pain Assessment Tool (NPAT) which are used in adult and pediatric patients with verbal impairment and for painfulprocedures.

Conclusion. According to the importance of pain management in intensive care units,   nurses must particularly apply valid tools for pain assessment to facilitate healing process and use of pain medications properly.

Abstract

Aim.The aim of this study was to examine the effect of family presence at the bedside on serum cortisol levels and physiological indexes increasing in stressful situations.

Background.Family has a significant role inrecoveryof patients. Stress andanxiety are perceived reasons for limiting visitation in critical care units.

Method. This was an interventional study performed in intensive care units of three teaching hospitals in Tehran, Iran. Thirty and six blood samples of 18 patients were taken for measuring serum cortisol level and physiological indexes during their admission in the critical care settings with restricted visitation. The samples were taken, before family presence and then, one hour after visitation. Simultaneously, blood pressure and heart rate were recorded. The blood samples were immediately centrifuged and plasma stored at 200C until laboratory measuring. Total serum cortisol level was measured using electrochemiluminescence method. Data were analyzed using SPSS version 21.

Findings.Therewasnostatistically significant difference inserumcortisol levels(P=0.70), systolic blood pressure(P=0.93), diastolic blood pressure (P=0.98), and heart rates(P=0.60), before and after visitation.

Conclusion: Family visitation doesn't cause stress. Unlike some common belief about relationship between family presence and stress in patients, it can be concluded that family visitation can be permitted, if patient desires.

Abstract

Aim.The aim of this study was to review the physical and social environment monitoring of the intensive care unit and examine how it affects the physiological status of the patient and family needs.

Background.Knowledge and skill in providing nursing care are the main factors affecting the recovery of patients in the intensive care unit (ICU). While a nurse or nursing unit can possess perfect critical care skills and knowledge, those are not the only factors that influence patient recovery. Including nursing skills in ICU is environmental monitoring and creating a pleasant environment with minimal stress. This monitoring includes control of light, sound, color, landscape, music and social support.

Method.This review was conducted by searching electronic databases and hand searching of library resources. Finding articles and research projects was conducted by using keywords on the internet and relevant sites.

Findings.Improvement of the environment in which care is provided not only helps in the healing process for patients, but also increases employee satisfaction and families affected. Environmental monitoring reduces stressful factors from ICU to rectify the effects of these wards for patients and also, reduces staff stress.

Conclusion.The use of research findings is an important part of improving the quality of care for patients in intensive care units and their families. The ICU setting has the potential to afford patients the best possible opportunity to heal if key stress-reducing elements are incorporated into its physical design. Such elements may reduce noise, offer privacy, add full-spectrum lighting, and assimilate color. As well as considering the physical design, a critical program that integrates the family and other healing measures is essential to the milieu of a healing environment.

Abstract

Aim. This paper reviews various positions for neonates admitted to Neonatal Intensive Care Unit (NICU), describes benefits and disadvantages of each position and suggests a clinical guideline to improve development.

Background. It has been known that development of active muscle tone begins at 36 weeks gestation, when the baby achieves a postural state known as physiological flexion. Premature babies suffer from low muscle tone because they have missed out on some or all of the substantial stages of muscle tone development in the uterus. Without appropriate intervention these babies may experience head flattening and cranial molding. Without support, gravity causes preterm babies shoulders and hips flatten onto the bed, often called ‘frog leg position’ and ‘W arm position’. This can result in inappropriate or delayed development and mobility challenges including the inability to crawl, stand, walk and problem in fine motor skills such as hand-mouth co-ordination.

Method. In this literature review, papers published during the last 15 years, were searched out through search engines and data bases: Science Direct, Google Scholar, Ebsco, Pub Med, Ovid, Proquest based on which 16 papers about neonatal positioning during nursing care were selected. Also, three neonatal textbook were used.

Result. One of the earliest neurodevelopmental strategies in the NICU is therapeutic positioning. Positioning of premature infant is an essential neonatal nursing care. These positions are supine, prone, side-lying, and head up tilted position. Many studies have shown that a variety of outcomes can be affected by different body positioning of premature infants. Every position has its own advantages and disadvantages, so each infant should be individually assessed and positioned according to condition, preferences and behavioral cues. Position changes should be slow and steady, so that the infant doesn’t become distressed and dislodgement of invasive and monitoring equipment can be avoided. Whenever possible, an infant should be touched gently and talked to before changing their position.

Conclusion. It is necessary to ensure that preterm and sick neonates receive individualized positioning appropriate for their musculoskeletal development in order to minimize complications. Infants receiving developmentally supportive care have been demonstrated better medical outcomes including shorter duration of mechanical ventilation and supplemental oxygen support, earlier oral feeding, and shorter hospitalization.

Abstract

Aim. This study assessed the knowledge of nurses about arterial blood gases interpretation in intensive care units of selected hospitals in Tehran.

Background. Measurement of arterial blood gases are widely used in intensive care units. The knowledge and mastery in interpretation of arterial blood gases is an essential skill for critical care nurses.

Method. This descriptive-analytical study was conducted on 117 nurses working in intensive care units at selected military hospitals in Tehran in 2013. Data were collected using a questionnaire consisted of 45 questions about personal and professional information, also in the domain of blood gases interpretation based on Bloom's classification of knowledge (judgment and evaluation phase). Data are analyzed by SPSS and descriptive and inferential statistics were presented.

Findings. Knowledge of intensive care unit (ICU) nurses was moderate to poor in arterial blood gas interpretation. A statistically significant difference was seen between the knowledge of the subjects in terms of some variables. Conclusion. Given the importance of arterial blood gases interpretation in ICUs, it is necessary to pay attention to in-service and continuing education programs for nurses.

Aim. This study was conducted to evaluate the effect of aromatherapy on ICU nurses' stress.

Background. Nursing, due to its high sensitivity, is known as one of the most stressful professions. ICU nurses experience more stress than other nurses. This stress can reduce the quality of patient care and results in nurses' feelings of inadequacy and depression. Aromatherapy, as a method of complementary medicine may reduce anxiety and warring.

Method: This was a quasi-experimental study in which 70 nurses, working in intensive care unit, were divided into experimental and control groups. Nurses' stress were measured before intervention, then intervention (inhalation of Lavendula using tags for 4 consecutive shifts, each shift for 20 minutes) was was applied for the experimental group (control group received no intervention). At the end of intervention in experimental group, the stress was again measured in both groups. Data were analyzed using the Chi-square and t-test in the SPSS, version 20.

Findings. After intervention, the mean of stress in experimental group (20.57±4.20) was not statistically different when compared with control group (22.43±5/24). But, in the experimental group, the mean of stress score after intervention (20.57±4.20) was significantly lower than the mean of stress score before intervention (22.32±4.61) (P=0/001). Comparing the groups, the changes in mean stress score before and after the intervention was statistically significant (P=0.001).

Conclusion: The findings of this study showed that the Lavender essence can reduce stress in ICU nurses. It is recommended that the aroma of lavender be applied to reduce stress in ICU nurses.

Aim. This study aimed at examining the effect of nursing care training program on outcomes of mechanically- ventilated infants.

Background. Mechanical ventilation in infants is considered as an invasive procedures with complications such as bronchopulmonary dysplasia, lung bleeding, obstruction or removal of the endotracheal tube, which are almost all preventable. Nurse have responsibility to avoid these complications.

Method. This study was a randomized clinical trial (outcome-based). The study included all infants undergoing mechanical ventilation in the neonatal intensive care unit of Comprehensive Women's hospital in Tehran. Nurses were trained over one month at bedside by the clinical instructor. Data on ventilator complications were collected of 120 cases from patients' medical records, before and after intervention. The data were analyzed by SPSS version 21.

Findings: A statistical significant decrease was seen in most outcomes. The incidence of bronchopulmonary dysplasia declined from 35% to 18%, re-intubation decreased from 57% to 33%, pulmonary hemorrhage declined from 32% to 13%, and pneumothorax changed from 55% to 35%. Duration of mechanical ventilation and length of stay also decreased significantly after intervention. No statistically significant decrease was observed in retinopathy of prematurity and death.

Conclusion. Educational program, especially by the coach, is effective on most outcomes of the infants under mechanical ventilation. Taking into account the workload of nurses and problems with attending in educational classes outside of the ward, it is recommended to hold education at bedside for nurses to improve quality of education.

Aim. The aim of the study is to investigate the need for hospital infection control and prevention.
Background. Nosocomial infections are among the major health problems which increase mortality and hospital costs, especially in intensive care units. Successful control of nosocomial infections depends on recognition of hospital challenges in this issue.

Method. This study is an overview study. The keywords “hospital infection” and “ICU”, alone or together, with Persian equivalents were searched in websites such as Iranmedex, CINAHL, Scopus, Medline, Embase, SID, PubMed, Magiran and Irandoc.

Findings. Based on the findings, the main causes of nosocomial infections included multiple procedures and invasive diagnostic and therapeutic treatments, especially in ICUs. Compromised immune system, duration of hospitalization, absence of hospital surveillance reporting system, inappropriate disinfection and sterilization of equipment, inappropriate physical structure of ICU, non-cooperative managers and departments, and lack of knowledge of medical staff, especially physicians and nurses.

Conclusion. Identifying causes of hospital infections and the use of especial measures to promote safety and enhance quality of care in the treatment and prevention of these infections are necessary for a comprehensive and integrated controlling program.

Aim. The aim of this study was to evaluate the effect of using “Pain Assessment Tool” by nurses on analgesics requirement and patient’s satisfaction after coronary bypass graft surgery.

Background. One of the main duties of caregivers in ICU is relieving patients’ pain. Using "Pain Assessment Tool" may have a positive effect on the choice of analgesics and dosage adjustment with patients’ requirements. More research is still needed.

Method. In a clinical trial, 153 hospitalized patients in the intensive care unit were selected randomly and were divided into two experimental (n=77) and Control group (n=76). The Pain Assessment Tool and pain management for 48 hours were implemented for conscious patients. Routine measures were taken into account for control group and the severity of pain and analgesic injection for experimental group were determined. In both groups, the amount of analgesics administered for pain relief, and patient satisfaction were recorded. Data were analyzed by SPSS version 16.

Findings. The use of Pain Assessment Tool increased the number of recipients of analgesic drugs and reduced their dosage over 48 hours in the experimental group. Also, the satisfaction of pain relief was higher in the experimental group than the control group (p<0.0001).

Conclusion. The findings of this study demonstrate the positive effect of Pain Assessment Tool on pain control, proper use of analgesics, prescribing the proper dose of analgesics based on patients’ pain and satisfaction improvement. The measurement of pain severity using Pain Assessment Tool, before and after analgesics administration is suggested.

Aim. The aim of this study was to evaluate the ethical sensitivity and its relationship with demographic characteristics in critical care nurses of Shahid Rajaee Heart Center in Tehran.

Background. Nurses are the largest group of service providers in the health care system, and must be aware of and sensitive to ethical issues related to their profession. Ethical sensitivity is the basis of ethics in nursing enabling nurses to take care of their patients effectively and ethically.

Method. In this descriptive-analytical study, 181 nurses working in the intensive care units of Shahid Rajaee Heart Center hospital were randomly selected. Data were collected through demographic questionnaire and standard questionnaire of the nurses’ moral sensitivity. Moral sensitivity has six aspects: respecting the patient independence, awareness of how to communicate with patients, professional knowledge, experiencing the ethical problems, using moral concepts in decision-making ethics, integrity and benevolence. The data were analyzed based on SPSS version 19, using descriptive and inferential statistics.

Findings. The mean score of nurses’ ethical sensitivity was 70.85±7.73 with the highest scores in the domain knowledge of how to communicate with patients and the lowest score was related to the domain the level of professional knowledge. Among the demographic variables, there was a statistically significant correlation of age, average weekly work hours, and years of working with ethically sensitive nurses; with the increase of age and experience, the moral sensitivity was also increased, while the ethical sensitivity decreased as a result of the increase of average weekly work hours.

Conclusion. Considering that moral sensitivity in this study was moderate, it is recommended that nurse managers standardize the weekly working hours of the nurses in intensive care units in order to increase the ethical sensitivity in nurses.

Abstract

Aim. The aim of this study was to examine the effect of music therapy on ventilation criteria in mechanically ventilated patients in the intensive care unit.

Background. Complications made by mechanical ventilation are so much and considerable. Improvement of ventilation criteria is one of the factors that facilitatesweaning from mechanical ventilation.

Method. This randomized controlled trial was conducted in intensive care units of a teaching hospital affiliated to Iran University of Medical Sciences, Tehran, Iran. Seventy patients were recruited based on inclusion criteria and randomly allocated to experimental (n=35) and control (n=35) groups. For experimental group, relaxing music therapy was played with headphone for 30 minutes, once in the morning and once in the afternoon for one day. For control group, headphone was used without music for 30 minutes, once in the morning and once in the afternoon for one day. In both groups, ventilation criteria of respiratory rate, peak airway pressure and arterial saturation of oxygen (SaO2) were recorded in four intervals. Data analysis was performed in SPSS version 18 using statistical test.

Findings. Comparing of trends of ventilation criteria in experimental group showed that music therapy significantly reduced the mean respiratory rate (p= 0.0001), while in the control group, the mean respiratory rate slightly increased with time. In experimental group, the mean airway pressure reduced significantly within 30 minutes (17.30±3.65) compared with the time zero (19.68±3.64) (p=0.001). In the control group, the mean airway pressure increased slightly. The amount of spo2 did not differ significantly between experimental and control group (P=0.051).

Conclusion. Implementing music therapy in mechanically ventilated patients admitted to intensive care unit can reduce respiratory rate and maximum airway pressure. These could reduce the work of breathing and facilitate weaning the patient from ventilators.