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Rafiei, Hossein
- Effect of Nursing Implemented Sedation and Pain Protocol on The Level of Sedation, Pain and Amount of Sedative and Analgesic Drugs Use Among Opium Addicted Critically Ill Patients
Authors
1 Department of Intensive and Critical Care, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran, IN
2 Department of Critical Care, School of Medicine, Kerman Medical University, Kerman, Iran, IN
3 Social Health Determinants Research Center and Department of Epidemiology and Biostatistics, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran, IN
4 Department of Critical Care, School of Nursing, Kerman Medical University, Kerman, Iran, IN
Source
Asian Journal of Nursing Education and Research, Vol 3, No 1 (2013), Pagination: 37-41Abstract
Background and Aim: Control of pain and sedation in addicted critically ill patients could be different from other admitted patients to intensive care unit (ICU). This study aimed to assess the effect of nursing implemented sedation and pain protocol on the level of sedation, pain and amount of sedative and analgesic drugs use in opium addicted critically ill patients.
Methods: In a prospective, randomized, controlled trial from September 2011 to June 2012, this study has been conducted in Kerman, Iran. We randomly assigned 37 addicted mechanically ventilated patients who admitted to ICU in two groups; while in intervention group (group I), patients sedated using sedation and pain protocol, in control group (group II), addicted patients received usual, none protocol directed sedation and pain. Using Richmond Agitation Sedation Scale (RASS) and behavioral pain scale (BPS), the level of sedation and pain of patients was assessed in the time of ICU admission and every 4 hours for the first 2 days. Dosage of sedative and analgesic medications used (Morphine and Midazolam) was recorded in special chart every 6 hours by researcher during this period.
Finding: Mean score of the RASS in time of ICU admission was -1.74±1.1 in group I and -1.81±1.1 in group II. During hospitalization in ICU, score of this scale reached up to -1.10±1.0 in group I and -1.63±1.1 in group II. In the time of ICU admission, mean of BPS in patients in group I and II were 7.9±1.3 and 8.0±1.6, respectively. During ICU stay, score of this scale reached to 5.8±1.6 in group I and 6.9±2.1 in group II. In addition, our results showed that group I patients have received less amount of Morphine and Midazolam in comparison with patients in group II.
Conclusion: Our results suggested that using nursing implemented sedation and pain protocol for opium addicted critically ill, could lead to experience better sedation and lower level of pain as well as decreasing amount of sedative and analgesics drugs use with implementation of protocol.
Keywords
Opium Addicted Patient, Nurse, Protocol, Sedation, Pain, ICU.
References
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- Normal Saline Instillation with Suctioning and its Effect on Oxygen Saturation, Heart Rate, and Cardiac Rhythm
Authors
1 Kerman Medical University, Kerman, Iran, IR
2 Faculty of Nursing and Midwifery, Kerman Medical University, Kerman, Iran, IR
Source
International Journal of Nursing Education, Vol 3, No 1 (2011), Pagination: 42-44Abstract
Background
Although the researches indicated disadvantages of using normal saline (NS) before suctioning, it still used by nurses in many Iranian critical care units.
Aim
The purpose of this study was to determine the effect of NS instillation on multiple trauma patients' oxygen saturation, heart rate and cardiac rhythm.
Setting and design
A cross-over design was used to allow sample to be as their own control. This study was approved by Kerman Medical University.
Methodology
50 multiple trauma patients who were admitted in intensive care unit and mechanically ventilated for at least 24 hours were randomly assigned to suctioning with or without NS. Surveyed parameters were measured and recorded at intervals of 1, 2, and 5 minute before and after suctioning by standard monitoring apparatus. EKG tapes recorded initiate 5 second before suctioning and continue during suctioning approximately 20 second.
Statistical Anlysis
A Kolmogorov-Smirnov test indicated that the data were sampled from a population with normal distribution. The comparison between the two groups in three measured factors was done using a descriptive analysis, and independent ttest, and cross table with chi-square test.
Results
Oxygen saturation in both groups was changed. In group 2(with NS), there was a decrease in oxygen saturation, whereas in another group, except at interval of 1 minute, there was an increase in oxygen saturation. This difference was statistically significant. In both groups, heart rate was increased after suctioning at three intervals. In both group there was not found dangerous arrhythmia .
Conclusion
This study suggests that instillation of NS before suctioning can cause adverse effect on oxygen saturation but has no effect on heart rate and cardiac rhythm. It seems that Iranian nurses believed that using NS have positive effects on suctioning. Such an attitude could be changed by some educational programs by which nurses can improve their knowledge about disadvantages of using NS with suctioning; and become aware of the strategies they can use to qualify suctioning.
Keywords
Intubated Patients, Normal Saline Instillation, Heart Rate, Oxygen Saturation, Cardiac Rhythm.References
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- Registered Nurses Perception of Medication Errors: A Cross Sectional Study in Southeast of Iran
Authors
1 Department of Clinical Research, Kerman University of Medical Sciences, Kerman, IN
2 Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, IR
3 Department of Medical-surgical Nursing, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, IR
4 Shafa Hospital, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, IR
5 Shahid Bahonar Hospital, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, IR
6 Social Health Determinants Research Center, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, IR
7 Department of Intensive and Critical Care, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, IR
8 Department of Medical-surgical Nursing, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, IR
Source
International Journal of Nursing Education, Vol 6, No 1 (2014), Pagination: 19-23Abstract
Aim: Nurses have an important role in decreasing Medication Errors (MEs). The purpose of this study was to determine registered nurses perception of MEs.
Method: In a cross-sectional study conducted in four educational hospitals in southeast of Iran, 238 registered nurses working within these hospitals were studied. Data were collected using Iranian nurses' medication errors questionnaire.
Results: Of the 238 nurses, 93.1% were women. Factors such as lack of staff to patients ratio, nurses fatigue from hard work, having difficulty to read physician's writing on the patients file, nurses' heavy workload and work in night shift were the most common causes of MEs development which determined by nurses.
Conclusion: MEs may affect negatively on patients' health. Nursing educational systems should have more attention to nurses' perception on MEs and could consider their view in planning and education in order to decline MEs.
Keywords
Medication Error, Nurse, Perception, Cross Sectional- Comparison between Intravenous and Epidural Injections of Fentanyl in Critically Ill Patients with Thoracic Trauma:Effects on Pain Level, Static Pulmonary Compliance, and Arterial Blood Gas
Authors
1 Department of Intensive and Critical Care Medicine, School of Medicine, Kerman University of Medical Science, Kerman, IR
2 Department of Intensive and Critical Care Nursing, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, IR
3 Department of Epidemiology and Biostatistics, School of Health, Shahrekord University of Medical Sciences, Shahrekord, IR
Source
Asian Journal of Nursing Education and Research, Vol 4, No 1 (2014), Pagination: 11-14Abstract
Background: The aim of present study is to compare the effects of epidural and intravenous injections of fentanyl on level of pain, lungs static compliance, and PaO2 in patients with thoracic trauma and surgery.
Methods: We studied 60 patients (age between 18 to 60 years) who were under mechanical ventilation due to their thoracic traumas. In order to reduce pain, patients randomly divided into two groups: group "E" whom received epidural injections of fentanyl (1 μg/kg/h); and group "I" whom received their fentanyl via intravenous injection (2 μg/kg/h) for 24 hours after admission in intensive care unit (ICU). Level of pain, static pulmonary compliance and PaO2 were recorded at 0, 2, 6, and 24 hours after ICU admission.
Results: In the first two hours after ICU admission, patients in group "E" experienced more pain and had lower level of PaO2 and lungs static compliance compared to the patients of group "I". Two hours after admission, score of behavioral pain scale decreased in patients of group "E" more than patients of group "I". The level of PaO2 and static pulmonary compliance also increased in patients of group "E" more than patients of group "I". This situation continued during the further times; i.e. 6 and 24-hour.
Conclusion: Our results revealed that in order to control the pain, increased lung compliance, and PaO2 in patients with thoracic trauma, we could use both intravenous and epidural injection of fentanyl simultaneously.
Keywords
Pain, Static Compliance, Pao2, Intravenous, Epidural, Fentanyl, Analgesic.- Critical Care Nurses’ Moral Distress in South-East of Iran
Authors
1 Department of Medical Surgical, Kerman Medical University, Kerman, IR
2 Department of Intensive and Critical Care, School of Nursing and Midwifery, Shahrekord University of Medical Science, Shahrekord, IR
Source
Asian Journal of Nursing Education and Research, Vol 3, No 3 (2013), Pagination: 129-133Abstract
Objectives: Critical care nurses are the key persons that deal with patients with life-threatening situations, and encounter many situations that may cause different levels of moral distress. This study aimed to assess the level of moral distress of critical care nurses in South-East Iran.
Material and Method: Translated Moral Distress Scale (MDS) consisting of 38-items was used to measure the nurses' level of moral distress and their perception of futile care. There were 141 nurses working in intensive care units (ICU) in South-East of Iran who completed the questionnaires.
Results: Nurses reported a moderate level of moral distress overall. The highest levels of moral distress belonged to the physician practice category. The lowest level of moral distress also belonged to the euthanasia category. Intensity of moral distress was significantly correlated with years of nursing experience.
Conclusion: An appreciative collaboration between critical care nurses and physician lets them to value each other as a health care system. Through such collaborations they can also have ethical meetings and discuss about ethically difficult situations occurred in order to find appropriate resolutions.