Effect of implementing nursing guidelines on occurrence of deep venous thrombosis for critically iLL patients

Deep venous thrombosis [DVT] is a major health problem that results in significant morbidity and mortality for the critically ill patients in the critical care units. It was documented that DVT occurs in about two million Americans each year, whereas pulmonary embolism [PE] as a complication of DVT causes approximately 50.000 to 60.000 deaths. Moreover, it was revealed by a study done in Assuit University Hospital that out of 220 surgical patients, 12[5%] died with pulmonary embolism as a complication of DVT. Other research done at Alexandria University in El-Hadra Hospital on 50 orthopedic patients revealed that seven patients were detected with DVT, The critical care nurses are the key players in the prevention of DVT and its complications. They are in the ideal position to asses patient risk factors early and ask for DVT prophylaxis. The current study was carried out to evaluate the effect of implementing nursing guidelines on the occurrence of DVT for critically ill patients. Four critical care unites were used to collect the data for this study at Assuit University Hospital, sixty critically ill patients were included in this study, they were divided into two groups G1 [control group] and G2 [interventional group] 30 patients each. Two tools were used to collect the data of this study. Tool one: "Patient's assessment for DVT, and Tool two: the "DVT evaluation sheet". Findings of the current study revealed low incidence of DVT for the global sample, only two patients experienced DVT in the control group, and none of the interventional group experienced DVT. Moreover, it was observed that the preventive measures of DVT done by the critical care nurses for the control group using non-pharmacological and mechanical methods were not adequately performed. In addition, it was found that all the studied patients of control group did not wear the elastic stocking, while small proportion of this group performed leg exercises, changed their position, did deep breathing, and coughing exercises, and transfer on the chair. It was observed that most of the studied patients experienced low percent of DVT manifestations with no statistical significant difference between the both groups. The present study revealed also that nearly half of the studied patients were in moderate and high risk grades for DVT in the both groups. Based on the current study findings it can be recommended that this research should be repeated on a large sample size and in multi centers for generalization. Moreover, training programs should be established to update critical care nurses' knowledge and skills about DVT preventive measures, and how to use the technical skills to assess the occurrence of DVT using the evidence base nursing and medicine

Relationship between women cardiovascular disease risk factors and the perceived social support: implications for risk reduction

Heart disease is one of the leading causes of death among women. Women have received little attention regarding the risk reduction of cardiovascular diseases. Until recently, the incidence and potential severity of heart disease in women were underrecognized. As new knowledge becomes available, it is imperative that critical care nurses be acquainted with these developments and use this knowledge in their practice to modify those factors and manage that changing needs in the women's health. This study was designed to identify women cardiovascular disease risk factors, to determine the relationship between these factors and the perceived social support, and to provide supportive interventions information for risk reduction. A descriptive study design. This study was conducted in the coronary care unit and outpatient cardiac clinic of the Specialized Medical Hospital, Mansoura University. 40 adult females diagnosed as cardiovascular diseased and able to communicate. The researchers assessed the studied women individually for cardiovascular risk factors in the first 48 hours, then they were asked to answer the questionnaire about the data related to their perceived social support. Before the day of discharge a pre-test was done for every woman to determine her need of knowledge about the parameters of the supportive interventions for cardiovascular risk reduction. Then on the day of discharge, individual interview for information giving that included instructions, restrictions, and expectations about nutrition, smoking, exercises, stress, medications, and follow up care. Booklet as a handout about health instructions for lifestyle change and cardiovascular risk reduction was given to each woman. Post-test was done after one month from discharge in the outpatient cardiac clinic to measure the changes. It can be observed that more than half of studied females were at medium risk for coronary heart disease [52.5%] and the majority of them [62.5%] have perceived moderate social support. No relationship was found between the score of cardiovascular risk factors and the score of perceived social support. The mean total score was 14.80 +/- 1.95 before information giving and 42.80 +/- 2.23 after information giving [Z=5.548, P< 0.05]. It can be concluded that assessment of cardiovascular heart disease risk factors of women, which remained for long time neglected, should be recognized and managed to reduce morbidity and mortality rates. Moreover, the unique contribution of the hospital-based nurses to provide information, as part of a multi-disciplinary team, to the recovery phase following acute CHD events is not explicit. Hence, emphasizes should be done on assessment of the patients individual needs for information. These information may be backed up by written handout, and supported by critical care nurses home visits follow up or telephone calls

Cancer related fatigue of patients receiving different modalities for cancer treatment

Fatigue is the most common symptom of illness affecting sufferers of both acute and chromnic conditions. The subjective feeling of fatigue is closely n linked to individual perceptions of illness from a nursing perspective. fatigue has been conceptualized as an "inability to continue in whatever " situations people find themselves " and described as a feeling of inability to mobilize the energy to carry on. It was reported that cancer-related fatigue is an immense problem associated with pervasive disturbances in quality of life. Despite the prevalence of fatigue in cancer patients and the extent to which it can interfere with daily activities, there is a limited research describing severity of cancer treatment related fatigue; and identifying measures that prevent or ameliorate fatigue. Prevention and treatment of fatigue must be addressed in the plan of care of cancer patient to minimize the negative impact of fatigue on the quality of life. This study was conducted to determine the severity of fatigue of cancer patients receiving different modalities for treatment [radiation and/or chemotherapy], to determine the factors that increase its severity, and to identify the measures used by the patients to relieve fatigue. Design: Descriptive survey, Setting: The present study was conducted in the oncology department in Alexandria Main University Hospital. Sample: Data were collected from cancer patient, of both sexes, who were admitted to Alexandria Main University Hospital for cancer treatment whether by, radiation and/or chemotherapy

Effect of body position on breathing patterns in patients with a large abdomen

The aim of the present study was to determine the body position that optimizes breathing pattern [tidal volume [TV] and respiratory rate [RR]] in spontaneously breathing, intubated patients with a large abdomen. 20 intubated patients with obesity, ascites and/or abdominal distention, who were on pressure support ventilation mode were studied in the 0 degree, 45 degrees, 90 degrees and the reverse Trendelenburg's [RT] at 45 degrees positions for 10 minutes, each before data collection. The RT at 45 degrees position resulted in a significantly lower RR than at 90 degrees, however no significant difference in TV was demonstrated. The results of this study indicated that the RT at 45 degrees position is the optimal position for weaning patients with a large abdomen from mechanical ventilation. The results also, have implications for the selection of chair and bed positioning during weaning trials

Preceptors impact on the outcome of an orientation training program for novice nurses in critical care

The sample consisted of 97 and 140 novice nurses graduated in the years 1996 and 1997, respectively. The first phase was the development and implementation of an orientation program for novice nurses in critical care units, regarding theoretical and clinical content. Whereas, the second phase was the hiring and training of preceptors in order to supervise, train novice nurses in the critical care units. Evaluation of the theoretical components of the orientation program was carried out on all novice nurses in the study. Evaluation of the clinical performance was done on 20 novice nurses in each year of the study. Findings revealed a statistically significant improvement in novice nurses' knowledge and performance gain after implementing the program were t value [= 9.02 and 5.83, respectively]. However, the preceptors value was markedly felt in the 1997 novice nurses' evaluation in a higher gain in critical care nursing performance

effect of psychological care on promoting burn patients' compliance with their therapeutic regimens

This study aimed at investigating the effectiveness of psychological care on promoting compliance of burn patients with their therapeutic regimens. The sample covered 40 adult burn patients. Selection criteria were patients with more than 15% burn surface area, ability to communicate, and free from psychiatric problems. Necessary data were collected using an assessment sheet to identify the psychological problems and coping scale to identify the coping patterns of the burn patients, in addition to a behavior rating scale to measure the changes in burn patients behavior pre and post-psychological care. Findings revealed a significant improvement in the burn patients' compliance with their therapeutic regimens, Chi-square test was used at 5% level of significance