Journal of Critical Care Nursing
Year:2009 | Volume:2 | Issue:1|Papers Count:8

Aims: Patients with coronary heart disease are influenced by the disease and heart surgery in different aspects that propounds special needs regarding their physical and mental conditions. This study performed to evaluate the effect of administering the continuous care model on quality of life of patients undergone coronary artery bypass graft (CABG) surgery.Methods: In this two-group clinical control trial study, 66 CABG patients undergone coronary artery bypass graft divided into experimental and control groups randomly and analyzed for two months. Continuous care model applied to experimental group and no interfering made on control group. Measurement of health-related quality of life took place using MacNew heart disease health-related quality of life questionnaire before, one month after and two months after the intervention in both groups. Data analyzed by repeated measurement ANOVA method and SPSS 15 software.Results: There was a significant difference among three fields of MacNew questionnaire mean scores in experimental group (p<0.001). The mean of quality of life scores in experimental group were 4.3±0.8 before intervention, 4.6±0.5 one month after and 6.3±0.2 two months after intervention. In the control group the mean scores were 5.4±0.8, 4.1±0.9 and 4.7±0.6, respectively.

Aims: The nursing society is under various pressures due to the special nature of the job and weakness of managers and lack of their familiarity with efficient management styles intensify these pressures. This study was to determine the influence of implementation of suggestions’ system on extension of organizational commitment of personnels working in ICU.Methods: This interfering and semi-experimental study performed on 118 ICU personnels in one control and two experiment groups by using pre- and posttest model for three months. In training group, suggestions’ system was only taught; In interfering group, suggestions’ system was taught and implemented. Data gathered through interview and organizational commitment questionnaire and analyzed by SPSS 11 software.Results: Significant difference seen in posttest stage, among the average of organizational commitment and its threefold aspects in all groups. In comparison of groups, there was significant difference in general organizational commitment between interfering and training groups (p=0.001), interfering and control groups (p=0.001) but no significant difference between control and training groups (p>0.05).Conclusion: Using suggestions' system that is based on young nurses thinking power and potentials beside older nurses experimental power is a strategy to progress and improve the nursing system.

Aims: Sedative medications are widely used in intensive care unit patients. Structured assessment of sedation and agitation is useful to titrate sedative medications and to evaluate agitated behavior with persian version of Richmond agitation/sedation scale.Methods: At first the english version of Richmond translated to persian and the initial persian version made by expert confirm. This version studied on 35 patients. Then the persian version translated back to english and evaluated in 35 other patients. After teaching to users (one anesthesiologist and 7 nurses), this scale studied in 2 phases on 120 adult ICU patients in one of the Tehran hospitals to measure the inter-rater reliability and validity.Results: Comparing the intraclass correlation coefficient (RASS; k) equal to 0.65 with visual analog scale (r) equal to 0.76 and interclass correlation coefficient (a) equal to 0.95 showed a significant correlation between the raters.Conclusion: Persian version of Richmond agitation/sedation scale is logical, easy to administer and readily recalled. It has high reliability and validity in medical and surgical, ventilated or no ventilated and sedated or no sedated adult ICU patients.

Aims: Coughing during unconseusness or after tracheal extubation is unwanted and possible that can be harmful in patients under cataract operation and cause damages to eye or finally blindness. Our goal in this study was to determine the effect of lidocaine injection via endotracheal tube before extubation in decrease of incidence of cough and laryngospasm in cataract operation after extubation.Methods: This is a double blind randomized clinical trial study, performed for 6 months in Yasouj Emam-Sajad Hospital on 66 above 18 year-old candidates of cataract operation. In control group, 100 mg (5ml) of lidocaine 2% and in test group, same volume of placebo (normal salin) injected via endotracheal tube. Using anesthesia drugs stoped 5 to 10 minutes before end of the surgery and after ending the operation extubation took lace. The number of coughs and laryngospasm recorded in three periods. Collected data analysed by SPSS 11.Results: Cystolic and diastolic blood pressure before operation, after extubation in operation room and in recovery room did not show a significant different in control and test group. Number of coughs was higher in control group and the difference between 2 groups was significant.Conclusion: Administration of lidocaine via endotracheal tube administration reduces coughing during emergence from general anesthesia without prolonging the emergence in cataract operation.

Aims: Ventilators designed to generate the alarms when patient have any problem. However, these alarms can blend in with other accustomed sounds of the intensive care unit. This study was to improve medical ventilator alarms in ICU by comparing vocal and beep alarms regarding to nurses and physicians opinion.Methods: Studied "vocal alarm" designed in Persian language and put on "Bennet 7200" ventilator. In critical conditions, vocal alarm system using a software microprocessor broadcasted recognized alarms in speech, respectively. 40 questionnaires from nurses, physicians and assistants collected and data analyzed with SPSS 11 software.Results: 22 (54.5%) of attitudes were unsatisfied with this belief that death is more occuring with vocal alarmed ventilator. Response duration for normal beep alarmed ventilators was longer than vocal alarms.Conclusion: The vocal alarms improve patient safety by alerting all medical staff in the ICU of all critical ventilator events. Using vocal alarm system reduces the response duration to alarms of the ventilator events.

Aims: Cardiovascular diseases and especially coronary artery disease is the main source of morbidity and mortality and coronary artery bypass graft (CABG) is still the main procedure for this widespread health problem. This study was to investigate the correlation between duration of post of intubation and the complication after CABG.Methods: A cross-sectional study performed on 600 consecutive patients undergone CABG in two Tehran hospitals and the correlation between complication after CABG and duration of post operation intubation studied using SPSS 11.5 statistical package.Results: The mean age of patients was 58.6±10.2 years and about 73% of the study population was males. The minimum and maximum intubation duration was 8.81 and 24.75 hours, respectively.Conclusion: The duration of intubation has significant correlation with post operation complications included post operation hemorrhage, reoperation, congestive heart failure after operation, cardiac arrest and hypotension after hemodynamic stability.

Aims: Increasing of acute myocardial infarction is a main cause of importance of emergency management for these patients. Streptokinase is a standard drug suggested by several international associations. This study was to evaluate the time period between entrance of severe heart stroke patient to hospital and streptokinase injection by nurses.Methods: This is a cross-sectional study performed on 150 consecutive patients admitted in CCU with acute myocardial infarction diagnosis. A researcher-made questionnaire used gathering data. Its validity accepted by agreement of 10 professors and its reliability accepted by test-retest method in 15 cases and spearman test (r=0.85). Data analyzed by parametric and non-parametric tests.Results: 12 patient (8%) expired in first day and 18 (12%) suffered from pulmonary edema. Mean of injection fraction was 46.15±8.81 and mean of door to needle time was 190.33±420.35 minutes. Relation between "confined day/door to needle time" variables (p<0.01; Sig=0.001) and "injection fraction/door to needle time" variables (p<0.05, Sig=0.007) was significant by Pearson test.Conclusion: Mean of door to needle time was 2 hours and 40 minutes more than standard time (30 minute). Nursing managers must pay more attention to this difference.

Aims: Nurses with sufficient knowledge are effective to improve the quality of nursing cares especially in critical units. One of the most emphasized features of critical care units nursing staffs is having knowledge. This study was to evaluate the knowledge of intensive care units nurses.Methods: In this study, 100 personnel of ICU and CCU of Semnan University of medical sciences' hospitals selected. The knowledge of these personnel about critical care determined using a questionnaire and analyzed by SPSS 11 software.Results: Considering personnel's awareness of intensive nursing care were low to moderate. There was no significant difference between awareness level and sex, age, locality of service, work condition and job experience.Conclusion: The critical units' nursing personnel need special information about work field. Therefore, according to real necessities of education it is recommended to pay more attention to moderation of texts based on specialization of nursing educating courses in different fields of its application.