Journal of Critical Care Nursing
Year:2012 | Volume:5 | Issue:2|Papers Count:10

Aims: Nursing documentations describes quality of nursing care delivery. One of the development indicators of health care is the existence of hospital information systems (HISs). The aim of this study was evaluation of the quality of nursing records through an electronic information system in the CCU in one of the educational hospitals in Lorestan.Methods: This study is a participatory action research. It was done in order to enhance quality of nursing documentations through four phases. This study was done on 630 recorded nursing documentations in 70 files existed in electronic information system of the hospital by using census method in 2011. The data gathering tools was the observational checklist of recorded nursing cares included 127 items in functions of vital systems, general cares and patient education. Data analysis was done by descriptive statistics.Results: Change in vital signs, chest pain, disrhythmias, patient’s appetite, amount of infusion and transfusion and changes position of more than 70%, dedicated maximum frequency of the complete record. But the possible complications, nursing interventions, patients’ responses to these interventions after infusion and transfusion and teaching drug diets hadn’t been recorded in any of the nursing documentations completely. Respiratory disorders (34.3%), anxiety and restlessness (35.7%) had the lowest frequency of complete recording, in spite of their high importance in CCU.Conclusion: Using the HIS, in some cases, the quality of nursing documentations is in high level, but according to the existing facilities, the enhancement is possible. Furthermore, it is recommended to prepare ready nursing documentations forms, place the network on the electronic portable devices or on the patient’s bedside, remote access of health team and accomplish applied researches.

Aims: According to the influence of professional attitudes on job satisfaction and improving of professional performance of nurses as a key member of the health teams, the present study has been conducted to compare the attitudes of the nurses working in the Critical Care Units (CCUs) and other wards.Methodology: This descriptive - analytic study was performed on 103 CCUs and 210 other wards nurses in hospital of Baqiyatallah (a.j.) and Jamaran cardiac hospital in early 2010. The subjects were selected through the systematic sampling method and investigated using a questionnaire on attitudes towards the nursing profession. The data was analyzed using SPSS15 software and descriptive statistic and chi square tests.Results: The study findings showed that 25.28% of CCUs nurses and 28.5% of and other wards nurses had negative or neutral attitudes towards their profession, and in spite of higher percentage of positive attitude among CCUs nurses, the difference was not statistically significant (p>0.05).Conclusion: In regard to this result that approximately   of the nurses in both groups, CCUs and other wards, had negative attitudes towards their profession, it is recommended to accomplish extensive practical researches to identify the causes and factors affecting nurses' attitudes toward the profession and to pursue management measures in order to induce positive attitudes and finally nurses' job satisfaction to enhance the quality of patient care.

Aims: Endotracheal suctioning is a vital process to keep the airways open. The method of performing endotracheal suctioning has a great effect on its complications and effectiveness. This study was carried out with the aim of assessing gap between the knowledge and performance of nurses’ working in intensive care units (ICU) in tracheal suctioning.Methods: In this cross sectional study, knowledge and performance of 44 nurses working in three ICUs in Shahid Beheshti Hospital, Kashan, Iran, was analyzed in three areas of prior, during and post suctioning, using a 26 item questionnaire and check list in 2010. kruskalwallis test, spearman correlation coefficient and SPSS14 software were used for data analysis.Results: In the 8 items in question of prior suction the average score for knowledge and performance were 5.4 (±1.12) and 0.81 (±0.71) respectively and in the analysis of ten items during suction an average score of 7.7 (±1.09) and 4.6 (±0.75) were obtained for knowledge and performance respectively. In 8 items of post suction the average score of knowledge was 6.47 (±0.69) and that of performance was 3.86. In general, from 26 possible points, the average score of knowledge and performance were 19.59 and 8.75 respectively. The type of ICU and nurses’ working experience were not significantly related to their knowledge and performance.Conclusion: This study revealed that despite acceptable knowledge, nurses’ performance in endotracheal suctioning is poor. This shows that education alone is not sufficient for observance of the standards.

Aims: Cardiopulmonary resuscitation (CPR) is the most important skill of clinical staff and it is necessary for them to be aware of its last changes. This study had been done to determine the awareness level of nurses of the last 2010 CPR guidelines.Methods: This descriptive cross-sectional study was conducted with 321 samples, which had been chosen with sample randomly method in Kermanshah’s hospitals in 2011. The tools for collecting data were a researcher made questionnaire with face and content and reliability of (r=%74). Data was analyzed by STATA-11 software and ANOVA, Tukay, Tamhane and Bonferoni tests.Results: Level of awareness was classified to: %20.2 excellent, %65.4 good, %14 moderate and %3 weak. There was no significant statistical correlation between level of awareness and age, work experience and graduate degree, but level of awareness was higher in nurses that had experience of passing CPR training, doing or observing it (p<0.001). The most score of awareness was related to external cardiac massage.Conclusion: It is suggested that to teach CPR according to guidelines of 2010 in nurses postgraduate training and to have more emphasis on electroshock therapy and Automatic External Defibrillation (AED), Laryngeal Mask Airway (LMA) and combitube intubations, reasons of termination and undoing of CPR interaoseus injection and induced hypothermia.

Aims: Effect of workplace violence is one of the most important reasons for leaving the nursing profession. This study aimed to assess the vision of intensive care nurses about workplace violence.Methods: A cross sectional study was conducted on intensive care nurses of Therapeutic and Educational Centers of Hamadan in 2009. By using quota sampling, a number of 170 nurses were selected. Data gathering tool was the modified Minnesota Workplace Violence Questionnaire which included 52 questions. Data were analyzed using SPSS 16 software and by descriptive statistics.Results: Prevalence of violence was 74.1%, most common kinds of violence were verbal misbehavior, threatening, physical battery and sexual assault and the most violence was from patients and their accompanies. The most violence was reported verbally and legal pursuit was little and the most common reason for that was nurses’ feeling that it is useless. Most of the nurses were dissatisfied with violence management in their institute.Conclusion: Despite high prevalence of violence, written reporting and legal pursuit of it was low. It seems, workplace violence can be reduced with educating the nurses, managers’ support, patients’ accompanies under surveillance, empowering the guarding unit and effective inter-individual relationship.

Aims: in order to review and determine the level of orientation, a standard scale is needed that shows ability the best type level of orientation. According to that in Iran, there are so far no measures the level of orientation Four Score made native. The aim of this study was to confirm the validity and reliability of Four Score scale in adult patients hospitalized in critical care units of Iran.Methods: This study is methodological. After translating the English version of Four Score scale to Persian, 155 patients in two trained and untrained evaluators group (120 patients in trained evaluators group and 35 patients in untrained group) hospitalized in critical care units of two hospitals of Tehran city were selected by no probable accessible purposeful sampling method. Six evaluators (main researcher, four nurse and anesthesia resident) independently and at the same time evaluated the patients. Main researcher and other investigators recorded the level of orientation with Four Score and Glasgow Coma scores.Results: Inter-rater reliability for Four score was “excellent”. Interclass correlation coefficient in trained and untrained group was (0.998, 0.993) and the weighted kappa score for inter-rater agreement was (0.981, 0.986). Validity tests showed a high correlation between Four Score with Glasgow Coma scale. (r=0.980, 0.925) (p<0.001).Conclusion: Validity and Reliability of Coma Scale (Four Score) are confirmed for assessing in Adult Patient Hospitalized in Critical Care Units in Iran.

Introduction: Triage is one of the most important managerial and decisionmaking concepts in emergency. Triage brings the most benefit to the greatest number of patients. In this regard, the present study was conducted to determine the level of knowledge and performance of medical emergency staff on pre-hospital triage.Methods: This descriptive study was carried out on 144 subjects of medical emergency staff of North Khuzestan selected through simple random sampling; data were collected using a researcher-made questionnaire, including five demographic questions, fifteen questions on triage knowledge, and nineteen questions on triage performance, the reliability of which was evaluated by re-test and Pearson correlation coefficient. Data were then analyzed by independent t-test, ANOVA and Pearson correlation analysis using SPSS18 statistical software.Results: The mean age of subjects and the years of experience was 31.32±3.9 and 4.20±2.68 years respectively. The mean triage knowledge score (5.69±2.5 out of a total score of 15), as well as triage performance (5.78±3.2 out of a total score of 19) were found to be in a poor level.Conclusion: Lack of knowledge and poor performance of medical emergency staff in terms of pre-hospital triage can be due to lack of a national guideline in the country’s medical emergency, and, hence, the authorities are recommended to make attempts to resolve this problem.

Goals: Tracheal suction is a method to clean the airway from discharge. This method is used for patients with reduced level of consciousness and respiratory muscle weakness who are not able to cough and discharge their secretions. There exist two suction systems: open suction system [OSS) and closed suction system [CSS). This study aims to improve application of closed suction in intensive care unit.Methods: This study is an action research.60 ICU nurses were selected through convenience sampling, 30 of whom were chosen by random sampling.The required data was gathered by the help of observation, interviews and the standard American Association of Critical Care Nurses [AACN) questionnaires. The following steps were exactly taken in the present study: precise statement of the problem, gathering information, planning and goal setting, implementation, and evaluation. In the present study, using the questionnaire and interview, problems associated with closed suction were prioritized and solutions were found out through silent brain storming and participation of nursing staff. Affordable solutions were eventually taken.Results: The prevalence of preference for using closed suction before the study was 10.5% and 66.7% afterwards. The frequency of using the open suction method, according to the connectedness of closed suction to patients, was 60% before the intervention and 57.1% after that. No significant difference was observed between the mean score of suction before and after the intervention [p>0.05).Conclusion: Action research is a suitable way to change and improve nurses’ performance, since in this method, taking the advantage of the staff’s comments and involving them in the study makes it plausible to bring about changes faster. Additionally, the made decisions would be more stable and reliable among the nursing staff.