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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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- 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.