Intensive care unit registered nurses' perceived barriers towards ventilated associated pneumonia prevention in southeast Iran: a cross-sectional descriptive - an analytical study.

OBJECTIVES: Ventilated associated pneumonia (VAP) is one of the most common nosocomial infection and complication occurring in intensive care units (ICUs) worldwide. This study aimed to assess the ICU registered nurses' perceived barriers towards VAP prevention in southeast Iran. SETTING: This was a cross-sectional descriptive-an analytical study to examine the registered nurses' perceived barriers towards VAP prevention in southeast Iran. PARTICIPANTS: The study population consisted of 242 nurses working in ICU and emergency departments. PRIMARY AND SECONDARY OUTCOME MEASURES: The data was collected using demographic characteristics' questionnaire and a researcher-made ventilator-associated pneumonia barriers prevention questionnaire. RESULTS: The mean score of nurses' perceived barriers towards VAP prevention was 2.82±0.46. The highest mean score of perceived barriers were related to items of 'lack of staff', 'lack of a team-based approach to care and interventions', and 'lack of support from management'. CONCLUSIONS: This study indicates most of the barriers are related to organisational factors and lack of teamwork. Further studies are needed to obtain more accurate results. TRIAL REGISTRATION NUMBER: The study protocol was approved by the Ethics Committee of Kerman University of Medical Sciences (IR.KMU.REC.1395.908).

Recall of Intensive Care Unit Stay in Critical Illness Survivors in Southeast Iran.

BACKGROUND: In survivors of critical illness, recall of an intensive care unit stay plays an important role in the development of post-intensive care unit syndrome, which includes psychological impairment after intensive care unit discharge. OBJECTIVE: To investigate memories of the intensive care unit among survivors in southeast Iran. METHODS: In this descriptive study, the intensive care unit memory tool was used to assess patients' memories of intensive care units. RESULTS: All participants (N = 100) had 1 or more factual memories (89%), memories of feelings (66%), or delusional memories (34%) from the intensive care unit. Patients who received mechanical ventilation were 4 times as likely to have delusional memories as those who did not receive mechanical ventilation. Unmarried patients were 4.8 times as likely as married patients to have memories of feelings from the intensive care unit. CONCLUSIONS: Steps should be taken to minimize distressing memories of an intensive care unit admission. Follow-up programs should take into account the psychological problems faced by intensive care unit survivors.

The Educational Needs of Family of Patients Discharged from the Intensive Care Units: The Viewpoints of Nurses and the Patients' Families.

INTRODUCTION: Thousands of patients are admitted to the intensive care units annually, which are stressful for patients and their families. The discharged patients and their families face different challenges in the caring process of the patients. OBJECTIVES: This study aimed to determine the educational needs of the families of patients discharged directly home from the postintensive care units and to compare the views of families and nurses about these needs. METHOD: This was a cross-sectional study. One hundred forty nurses and 140 family members of the patients discharged from intensive care units participated in the survey by convenience sampling method. A questionnaire of sociodemographic information and a researcher-made questionnaire on the educational needs of the family of patients discharged from the postintensive care units were used for data collection. RESULTS: The mean total score of the educational needs of the patients' families was 31.81 and 35.33 from views of families and nurses, respectively. Nurses significantly estimated the educational needs of families more than what they did (P < 0.001). The families and nurses reported the educational needs of self-care as well as nutrition and medicine at the highest level, respectively. Both groups reported the educational needs of defecation at the lowest level. Nurses estimated higher educational needs in all dimensions, except for the patient's mental health and family self-care than families (P < 0.001). CONCLUSION: According to the present study, the educational needs were high from the views of nurses and families. Family need assessment is essential in designing and applying instructional interventions. Given the high level of family needs, implementing educational and practical interventions is necessary to enhance their skills.

Informational Needs of the Families of Patients Discharged From Intensive Care Units: A Case of Iran.

BACKGROUND: thousands of patients are admitted to intensive care units annually, which is a stressful event. Many of these patients still require particular care after discharge. In many countries, families play an essential role in taking care of these patients after discharge. This study aimed to determine the informational needs of families of patients discharged from Intensive Care Units (ICU), Kerman, southeast Iran. METHODS: this study had a cross-sectional design. Families were selected using the information extracted from patients' medical records. One hundred forty family members of the ICU discharged patients participated in the survey using convenience sampling. Data collection tools were a validated researcher-made questionnaire about informational needs and a demographic characteristics form. RESULTS: the mean score of family informational needs was 31.18 ± 3.97 out of 40. Most families required a high level of information in all dimensions. However, the maximum need was associated with self-care subscale (4.89 out of 5), and the minimum need was associated with defecation (3.13 out of 5). CONCLUSION: the families of patients discharged from intensive care units required much information about different areas of care particularly self-care. Health care providers, especially nurses, should be aware of the informational needs of the ICU patients' families post-discharge to provide better care.

Post-traumatic stress disorder in critical illness survivors and its relation to memories of ICU.

BACKGROUND: Stressors in intensive care units (ICUs) are sometimes so severe that they result in Post-traumatic Stress Disorder (PTSD) in ICU survivors. The memories that survivors have from the ICU may play a role in developing PTSD. AIM: This study aimed to determine the prevalence of PTSD-related symptoms in ICU survivors in Southeast Iran and its relationship with their memories of the ICU. METHODS: In this descriptive correlational study, 100 people discharged from ICUs in southeastern Iran completed the Impact of Event Scale-Revised (IES-R) and ICU memory tool (ICU-MT). RESULTS: Findings indicated that, from 100 participants who, on average, were assessed 3.19 ± 5.37 months after discharge, 13% were suffering from PTSD. The total mean IES-R score and the scores of "Intrusion," "Avoidance," and "Hyperarousal" subscales in patients with delusional memories were higher compared with the patients who did not have such memories. In the patients who were mechanically ventilated at the time of their stay in the ICU, the total mean IES-R score was 6.86 times higher (P = .03). CONCLUSION: This research provided further evidence of the relationship between delusional memories and PTSD in patients who had been discharged from the ICU. RELEVANCE TO CLINICAL PRACTICE: In the care of patients admitted to the ICU, preventive strategies should be used to minimize delusional memories and PTSD. It is necessary to detect post-ICU psychiatric morbidities and provide early psychological intervention in post-discharge follow-up programmes to improve psychological outcomes after critical illness.

Effect of Foot Reflexology on Pain, Fatigue, and Quality of Sleep after Kidney Transplantation Surgery: A Parallel Randomized Controlled Trial.

MATERIALS AND METHODS: The study was a parallel randomized controlled trial. Patients admitted to the transplantation ward participated in the study. Fifty-three eligible patients were allocated into the foot reflexology group (n = 26) and the control group (n = 27) by using the stratified randomization method. Finally, 25 participants in each group finished the study. The intervention group received foot reflexology for 30 minutes once a day for three consecutive days, and no reflexology was applied in the control group. The intervention started on the second day after surgery. Pain, fatigue, and quality of sleep were measured on the first, second (before intervention), third, fourth, and eleventh days after surgery. Data were collected using visual analogue scale for measuring pain and fatigue and Verran and Snyder-Halpern sleep scale for measuring quality of sleep. RESULTS: In each group, 25 patients finished the study. The mean pain score in the foot reflexology and control groups decreased from 9.44 ± 0.96 and 9.36 ± 0.91 on the day of surgery to 1.32 ± 0.94 and 4.32 ± 1.68 on the eleventh day after surgery, respectively. The mean fatigue score in the reflexology and control groups decreased from 8.76 ± 1.27 and 8.6 ± 1.26 on the day of surgery to 1.24 ± 1.2 and 3.92 ± 1.63 on the eleventh day after surgery, respectively. The mean sleep score in the foot reflexology and control groups increased from 33.38 ± 11.22 and 39.59 ± 12.8 on the day of surgery to 69.43 ± 12.8 and 56.27 ± 8.03 on the eleventh day after surgery, respectively. While pain, fatigue, and sleep quality scores improved in both groups, those in the intervention group showed significantly greater improvement compared with the control group (P < 0.001). No significant difference was found between the two groups in the use of acetaminophen on the first, second, third, fourth, and eleventh days after surgery (P > 0.05). CONCLUSION: Foot reflexology may reduce pain and fatigue and improve sleep quality of patients after kidney transplantation.

The Effect of Foot Massage on Pain of the Intensive Care Patients: A Parallel Randomized Single-Blind Controlled Trial.

MATERIALS AND METHODS: This randomized, parallel, single-blind controlled trial study was performed on 75 ICU patients. Patients were allocated into three groups (massage by a nurse, massage by the patient's family, and control group) by the minimization method. Swedish massage was provided for the patients in experimental groups (each foot for 5 minutes) once a day for six days. The pain was examined in all three groups before, immediately, and one week after the intervention. RESULTS: The mean scores of pain in the groups of foot massage by the patient's family and by a nurse showed a significant reduction at the end of the study (from 4.48 to 3.36 and 4.76 to 2.96, respectively). The control group had significantly more pain after the intervention than the family-based massage group and the nurse-based massage group (P < 0.05). Although significant difference was found in the mean scores of pain between the massage provided by a nurse and that provided by the patient's family immediately after the intervention (P < 0.05), it was not significant one week after the intervention (P > 0.05). CONCLUSION: Using foot massage, by both nurses and family members can reduce the pain of ICU patients. This intervention may improve the nursing care quality with the least cost and complications.

Relationship Between Caregiver Burden and Family Functioning in Family Caregivers of Older Adults With Heart Failure.

Caregivers of individuals with heart failure are at high risk for diminished quality of life because of the energy involved in providing necessary care. Caring for someone with chronic heart failure can affect caregivers' physical, psychological, and social health, collectively referred to as the burden of care, and may also affect family functioning. The current cross-sectional study aimed to investigate the relationship between caregiver burden and family functioning in caregivers of older adults with heart failure in southeastern Iran using the Zarit Burden Inventory and the Family Assessment Device based on the McMaster Model of Family Functioning. The Pearson correlation coefficient, independent t test, and analysis of variance were used to determine relationships among variables. Results showed a significant correlation between burden of care and total score of family functioning. Therefore, it is necessary to take measures to reduce burden of care for caregivers through education and support programs and to improve their family functioning and quality of life. [Journal of Gerontological Nursing, 46(6), 25-33.].