ABSTRACT
Background: The process of making decisions to discharge patients from the intensive care unit (ICU) is very complex and risky, and decisions need to be made under time constraints and based on fair allocation of resources. In this situation, decision-making requires team participation, which is often accompanied by tension and conflict between team members and sometimes family members, which in turn affects patient safety and quality of care. Objectives: The aim of this study was to explore the experiences and perceptions of physicians and nurses regarding the decision-making process in transition of patients from the ICU to the general ward. Materials and methods: This qualitative study was conducted based on purposive sampling among six nurses and six physicians in Governmental teaching hospitals. The data collection process was conducted from July 2018 to January 2019 through a semistructured interview. Interviews were transcribed and data analysis was accomplished according to the steps proposed by Graneheim and Lundman (2004). Results: Data analysis revealed six themes that reflected factors influencing decision-making in transition of patients from the ICU to the general ward: contingent decision-making, risky decision-making, lack of coherence in team decision-making, differences in clinical judgment, legal and ethical responsibility, and lack of clear criteria. Conclusion: The process of decision-making regarding patient transfer from the ICU is a complex and stressful one. It is affected by situations, team participation, clinical judgment skill, legal issues, and multifactorial challenges. To improve decision-making processes, we need to develop abilities and knowledge and design proper interventions to achieve a principled and correct decision-making process. How to cite this article: Ghorbanzadeh K, Ebadi A, Hosseini M, Maddah SSB, Khankeh H, Pishkhani MK, et al. Factors Influencing the Decision-making of Healthcare Providers Regarding the Transition of Patients from the Intensive Care Unit to the General Ward in Iran: A Qualitative Study. Indian J Crit Care Med 2022;26(5):568-573.
ABSTRACT
BACKGROUND: Nursing Delirium Screening Scale (Nu-DESC) is a new instrument for determining delirium by nurses. The study aimed to investigate the psychometric properties of Nu-DESC and determined the sensitivity and specificity of it. METHODS: Two evaluators assessed delirium by Nu-DESC in nonintubated patients admitted to intensive care unit (ICU) wards of Ardabil educational and medical centers. For determining psychometric properties of the instrument, the methods of determining content validity, structural validity, criterion validity (the DSM-5 criteria was used as a standard tool), internal consistency, and inter-rater reliability were used. RESULTS: Ninety-six participants were assessed two times using the Nu-DESC. The mean age of the participants was 58.84, and 51 (53.1%) of them were male. Due to the high correlation of the Nu-DESC with the study criterion (DSM-5), the criterion validity of the instrument is confirmed. By using DSM-5 instrument, the cutoff score of 2 shows the best sensitivity and specificity. The kappa and alpha coefficients were obtained as r = 0.96 and α = 0.86, which indicate a good agreement between the evaluators and acceptable consistency. CONCLUSION: Nu-DESC can be used as an efficient and reliable instrument by nurses in the ICU. It was also found that taking medical history can help nurses to better interpret the Nu-DESC score at diagnosing delirium. HOW TO CITE THIS ARTICLE: Amirajam Z, Noran EA, Molaei B, Adiban V, Heidarzadeh M, Darghah MH. Psychometric Properties of Nursing Delirium Screening Scale in Patients Admitted to Intensive Care Units. Indian J Crit Care Med 2021;25(6):680-684.
ABSTRACT
BACKGROUND AND AIM: There are few reports from Iran about the epidemiology and clinical features of inflammatory bowel disease (IBD). In this study, we aimed to determine the epidemiologic profile and clinical features of ulcerative colitis (UC) in Northwest of Iran. METHODS: This retrospective study covered the time period from 1998 to 2008 and included all patients of a private gasteroenterology clinic in the northwest of Iran, who had diagnosis of UC at the time of presentation or those whose diagnosis had been made later. In addition to description of epidemiology and clinical feature of disease, an attempt was made to identify factors associated with severity of disease. RESULTS: A total of 105 patients including 61 females (58.1%) were evaluated. Mean age of the patients was 33.5 +/- 13.1 years. The median time interval from initiation of symptoms to diagnosis was 9 months. The commonest presentation was proctosigmoiditis. (48.6%). Among extra-intestinal manifestations, sclerosing cholangitis had the highest frequency and was found in 2 (1.9%) patients. Among all evaluated variables, only family income (the higher the income the more severe the disease) and cigarette smoking (inverse association) were find to have significant association with severity of disease. CONCLUSION: A case profile of patients with ulcerative colitis from Northwest Iran suggests that the disease is seen most commonly in the third decade of life with a female preponderance. Family income and smoking influenced the course of ulcerative colitis in Iranian patients.
