Journal of Critical Care Nursing
Year:2015 | Volume:8 | Issue:1|Papers Count:9

Aims: Evidence-based nursing guidelines can significantly improve the quality of nursing care. A key prerequisite for improving care quality is quality assessment. Meanwhile, a key indicator of healthcare quality is the quality of nursing care. The aim of this study was to investigate the effects of implementing evidence-based guidelines on the quality of nursing care provided to patients with angina pectoris.Methods: This pretest-posttest clinical trial was conducted in 2014 on 76 patients in Khatam Al-Anbia hospital, Gonbad-e Kavoos city, Iran. A standardized questionnaire was used for assessing the quality of nursing care standards both before and after educating evidence-based nursing guidelines. The SPSS15 was used for conducting statistical tests such as the paired- and independent-samples t and the Chi-square.Results: Before the study, the means of documentation quality in four areas of nursing diagnosis, care planning, implementation, and evaluation were respectively 0.94 (0.19), 0.63 (0.10), 11.57 (0.23), and 2.57 (0.18), and. After the study, these values increased to 3.2 (0.14), 3.52 (0.17), 15.36 (0.22), and 5.7 (0.23), respectively. The differences between the pretest and posttest readings were statistically significant (p<0.001).Conclusions: Given the significant effects of implementing evidence-based nursing guidelines on the quality of nursing care standards, educational managers of hospitals need to develop effective strategies for facilitating evidence-based nursing practice.

Aims: Hospitalization in coronary care unit is stressful for patients. Family members and visitors’ lack of knowledge related to their manner of behaving with their patients increases patients’ stress and dissatisfies them with visitation. This study was conducted to examine the effects of training hospital visitors on satisfaction of patients hospitalized in coronary care units.Methods: This quasi-experimental study was conducted on 124 patients hospitalized in Rafsanjan coronary care unit, Rafsanjan, Iran. In the experimental group, visitors were trained in areas such as emotion and feeling management, patients’ underlying problems, equipments and devices used in coronary care units, effective visitor-patient communication, and patients’ rights during visitation. A researcher-made scale was used for assessing patients’ satisfaction with visitation both before and after the study. Study data were analyzed by using the SPSS18.Results: After the study, the level of patients’ overall satisfaction with visitation in the experimental group increased significantly (p<0.0001). Moreover, compared with the control group, the levels of patients’ satisfaction with nursing care, visitation, and visitors’ comments and emotional reactions were significantly higher in the experimental group (p<0.05).Conclusions: Study findings highlighted the importance of paying careful attention to visitation and visitors. Providing planned trainings to visitors can enhance patients’ satisfaction and facilitate their recovery.

Aims: End-stage renal disease is a major health challenge worldwide. Patients with this disease need to receive frequent hemodialysis. The disease and hemodialysis both negatively affect patients’ quality of life. The aim of this study was to investigate the effects of Benson’s relaxation technique on quality of life among patients receiving hemodialysis.Methods: A convenience sample of 60 patients receiving hemodialysis in Imam Reza Hospital, Kermanshah, Iran, was recruited to this clinical trial. Initially, patients’ quality of life was evaluated by a disease-specific questionnaire. Then, patients were randomly allocated to either the control or the treatment groups. Patients in the treatment group were trained to perform Benson’s relaxation technique at their home on a daily basis for 60 consecutive days. Patients in the control group received no relaxation intervention. Immediately after the study, the same questionnaire was used for reevaluating patients’ quality of life. The independent-samples t-test was used for data analysis.Results: After the study, the mean scores of general and total quality of life were significantly higher than the corresponding pretest readings (p=0.001 and 0.02, respectively). However, the mean score of specific quality of life did not change significantly after the study (p=0.2).Conclusions: Benson’s relaxation technique has positive effects on quality of life among patients receiving hemodialysis and therefore, it can be used for enhancing patients’ quality of life in hemodialysis units.

Aims: One of the commonest complications of hemodialysis is infection secondary to central venous catheterization. The aim of this study was to compare the effects of chlorhexidine and povidone-iodine (Betadine) on bacterial colonization and local infection at Shaldon catheter insertion site among patients receiving hemodialysis.Methods: This study was conducted by using a Quasi-experimental design in 2013. In total, 56 patients who had undergone central venous catheterization for receiving hemodialysis at Golestan hospital, Ahvaz, Iran, were recruited and randomly allocated to either the chlorhexidine or the Betadine groups. The catheter insertion site in the chlorhexidine and the Betadine groups was cleaned and disinfected by using chlorhexidine 4% and Betadine 10%, respectively. Groups were then compared with each other in terms of bacterial colonization and local infection at catheter insertion site. The SPSS16 was used for performing the Fisher’s exact, the Chi-square, and the independent-samples ttests.Results: The incidence of bacterial colonization and local infection at catheter insertion site in the chlorhexidine and the Betadine groups was 3.6% and 21.5%, respectively. The Fisher’s exact test showed a significant difference between the two groups regarding bacterial colonization (P value<0.001).Conclusions: Chlorhexidine is more effective than Betadine in minimizing bacterial colonization and local infection at the insertion site of Shaldon catheter among patients receiving hemodialysis.

Aims: According to the latest evidences designing and applying nursing cares standards can lead to the best results in increasing quality of care”, this study is done with the aim of “designing evidence-based nursing care Guidelines for neurosurgical patients in Intensive Care Unit”.Methods: This evidence-based developmental study was done in neurosurgical ICU of Baqiyatallah Hospital in 2014. At first the quality of six available nursing care Guidelines was evaluated via a standard check list in three levels: good, moderate and weak. Then, the new nursing care Guidelines were designed according to the settler model, evidence-based approach and nursing process. Then their quality was evaluated again. In order to assess content validity of the guidelines through Delphi method, opinions of ten faculty members of Baqiyatallah, Mazandaran, Artesh and Shahid Beheshti Universities had been considered in three refers. Applicability of the guidelines had been assessed by focused group discussion method with the presence of ten experienced experts of Intensive Care Units.Results: Quality of all 6 available Guidelines was proven to be weak. At the end 26 new evidence-based Guidelines were designed with good quality for neurosurgical patients in ICU.Conclusions: Considering results of quality evaluation of the available nursing care Guidelines, designing new high quality evidence-based Guidelines is important and necessary for improving quality of nursing care in other wards. Performing these guidelines is recommended in the next studies.

Aims: EMS personnel and hospital emergency staffs experience many stressful situations which predispose them to post-traumatic stress disorder (PTSD). The aim of this study was to evaluate the relationship between personality traits and PTSD among EMS personnel and hospital emergency staffs in Kerman, Iran.Methods: This cross-sectional study was conducted in 2013. All 180 EMS personnel and 321 hospital emergency staffs affiliated to Afzalipour, Shafa, Bahonar, and Shahid Beheshti hospitals and the National EMS System, Kerman, Iran, were recruited by using the census method. The NEO Five-Factor Inventory and the Mississippi combat-related PTSD scale were used for data collection. The SPSS v. 19 was employed for conducting the Chi-square, the Pearson’s correlation, the independent-samples t, and the one-way analysis of variance tests.Results: EMS personnel’s PTSD was significantly correlated with personality traits of conscientiousness and neuroticism (P-value<0.01). In the hospital emergency staffs group, PTSD was correlated with personality traits of conscientiousness, neuroticism, and openness (P-value<0.05). The means of hospital emergency staffs and EMS personnel’s PTSD scores were 97.02±21.51 and 89.30±19.17, respectively.Conclusions: EMS personnel and hospital emergency staffs experience great levels of occupational stress and hence, are at great risk for PTSD. Both EMS personnel and hospital emergency staffs have personality traits which predispose them to PTSD.Consequently, health authorities need to implement in-service stress management programs for them and use personality traits as a condition for employing new EMS personnel and hospital emergency staffs.

Aims: Nowadays using research results is an important issue in nursing and it is linked to the quality improvement. Although in developed countries, professional nurses are trying to establish their practice based on research evidences, nursing care is a routine-oriented practice in Iran. Since for changing every kind of people’s behavior we need to know their attitude towards that issue, this study was conducted to determine nurses’ attitude towards using research results in clinical practices.Methods: In this descriptive study, 234 ICU nurses of educational hospitals in Ardebil Medical Sciences University have been selected through census method in 2013. A two-part researcher-made questionnaire was used to measure the attitude. The first part measured demographic information and the second part measured the attitude towards research. Data analysis was done by using SPSS18 statistical software and descriptive and inferential statistical tests.Results: The results indicated that 69.2 percent of the samples had positive attitude and 27.4 percent had neutral attitude and 3.4% had negative attitude towards using research results in clinical practices. There was a significant statistical relationship (p<0.05) between level of studying clinical articles and the working ward with the mean of attitude score.Conclusions: Most of the nurses have positive attitude towards using research results in clinical practices. Therefore designing some mechanisms for providing the conditions of using research results such as easy access to publications and introducing information resources is an effective step in implementation of research-based cares.

Aims: The Revised Geneva Score (RGS), a standardized Clinical Prediction Rule for Pulmonary Embolism (PE), was recently developed. We have measured its predictive accuracy, performing an external retrospective validation in a cohort of Emergency Department (ED) patients, filtered by symptomatology and not by clinical suspicion, to allow its use in nursing practice.Methods: The clinical probability of PE was assessed in 1013 consecutive patients with symptoms of “chest pain” or “shortness of breath/dyspnea”, whose clinical records were obtained during a two months period, in an Italian ED. The accuracy of RGS was analyzed by the Receiver Operating Characteristic (ROC) analyses; the OR was evaluated with an analysis of the risk raw score.Results: The overall prevalence of PE was 1.09%. The prevalences of PE in the three probability categories were similar and not statistically significant. The Area under the Curve was 0.6373 (CI 0.4336-0.8409). However, the NPV was 0.993 (95% CI 0.981-0.998) and the mean score of risk was 3.36 for the 1002 not affected by PE and 5.73 for the 11 subjects with Pulmonary Embolism (p 0.0003), by exclusively assessing it on the raw score obtained.Conclusions: This study suggests that the performance of the RGS, modified in order to be applied to a nursing emergency approach, gives good results in NPV; it should be also tested to assess the embolic risk by a dichotomous numerical score (rule-in/rule-out), that should be used to supplement rather than as a substitute for clinical judgement.