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Introduction : Anxiety has many devastating effects on the individuals, so this study aimed to determine anxiety level and psychological and environmental factors on anxiety of the family of the patients hospitalized in Intensive Care Units. Methods : This was a cross-sectional study conducted in 2007. 218 family members of 130 patients were selected in simple sampling method in meeting times of the Therapeutic Educational Centers . Collecting the data was done using two questionnaires: “standardized hospital anxiety and depression scale” and “researcher made”. The data were analyzed using chi-square test and logistic regression through software SPSS 15. Results : The odds ratio of anxiety outbreak in individuals who remarked that visiting behind the window affect their anxiety was 4.4 times more than that in the individuals who remarked visiting behind the window does not affect their anxiety (OR = 4.404). In addition, the odds ratio in cases with lack of face to face visiting, poor economic condition, family concerns on hospital costs and family member role changing were 3.550, 3.904, 2.501 and 4.308, respectively. Conclusion : Observing pipes and fittings, visiting behind the window, lack of face to face visiting, poor economic condition, family concerns about hospital costs and family member role changing were the effecting factors in increasing odds ratio of the families’ anxiety. Considering these factors and family-centered cares can significantly reduce anxiety level of the families.

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Abstract Aims: Drug interaction occurs when a drug affects the action of another. In this line, the present study has been conducted to determine the prevalence of potential drug interactions in critical care units. Methods: In the present retrospective study, the first twenty-four hour prescriptions of 371 patients admitted to intensive care unit of Shahid Bahonar hospital of Kerman were investigated in terms of the number and type of drug interaction in addition to other factors such as number of drugs, age, gender, length of ICU stay and number of prescribing doctors. In order to determine the number and type of drug interactions, a reference textbook of "Drug Interaction Facts" was used, and data analysis was performed by SPSS18 statistical software with respect to the study objectives using descriptive statistics, Pierson correlation test, independent t-test, and variance analysis. Results: In terms of the drugs received, 77 different drugs and, in total, 2091 cases of drug prescription were found with the average of 5.6 (±1.5) for each patient. Overall, 726 cases of drug interactions were observed among critical care unit patients in the first 24 hour of prescription. Delayed, moderate, and possible interactions were accounted for the most interactions found. The results are indicative of a significant correlation between the number of drug interactions and prescribed medications, age, gender, duration of hospitalizations and number of prescribing doctors. Conclusion: Due to possessing more risk factors of drug interactions, critical care unit patients are at higher risk of developing drug interaction which behooves the medical team to pay more attention to this issue.

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Abstract Aims: Identification of priorities in intensive care units is a matter of high complexity due to dysfunction in patients' vital organs such as blood, lung and kidney which often undergo rapid changes in the mentioned wards. Nurses should therefore be able to make decisions with respect to priorities to resolve this problem. In this regard, the present study was undertaken to investigate the efficacy of APACHE II instrument. Methods: In the present study in 2010, 70 patients of intensive care units with congestive heart failure and chronic obstructive pulmonary disease were evaluated, for whom the APACHE II scores were calculated. The research was conducted in a cross-sectional approach, in which patients' death or survival was recorded. SPSS15 statistical software was applied for statistical analysis, and clinical parameters were investigated using descriptive-statistical tests. Results: The study findings showed significant difference between survivors and non-survivors with respectively 3.5 (±13.6) and 17 (±2.5) as the mean (±SD) APACHE II scores. Fifteen percent mortality rate was observed in patients with scores under 15, while it was 36% in those with scores ranging from 16 to 19, and almost 100% in participants obtaining 20 to 30 scores. Conclusion: The APACHE II scoring system has been successful in predicting the mortality rate in intensive care unit patients and it has been found to be higher than the standard level in all patients.

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Aims: Most patients hospitalized in intensive care units suffer from restlessness, confusion, and delirium. Physical restraint seems to be the only acceptable measure for ensuring patients’ own and others’ safety in certain cases in which other interventions are not applicable or useful. The aim of this study was “to evaluate the application of physical restraint standards in intensive care units”. Methods: This was a cross-sectional descriptive study. A convenient sample of 120 physically restrained patients was recruited from the intensive care units of selected hospitals of Tehran University of Medical Sciences, Tehran, Iran. The data collection tool was an observational checklist for physical restraint standards. The SPSS16 was used for calculating the measures of descriptive statistics and conducting statistical tests. Results: Most of the participating patients were male (65.8%), aged 50–60 years (62.5%), and had a Glasgow Coma Scale score of less than 8. The Fisher’s exact test revealed a significant difference among the studied intensive care units and also among the three phases of using restraint (i.e. before, during, and after restraint use) regarding the rate of applying restraint standards (p≤0.001). Moreover, restraint standards were minimally applied in the study setting. Conclusions: Educating nurses—as the first decision makers for restraint use—and familiarizing them with restraint-related clinical guidelines are crucial.

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Background: In dealing with the new challenges of the health system, the head nurses of intensive care units need continuing educational programs, and investigating the learning requirements is the infrastructure of developing human resources.

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Background: One of the most common problems in intensive care units (ICUs) is pressure ulcer or bed sore and its prevention is a priority in nursing cares.

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Background: One of the important duties of nurses is to protect patients against any injuries. In most cases, physical restraint is applied as one of the immunity tools. In cases that other actions are not possible, physical restraint seems to be one of the acceptable interventions to protect patients or personnel of the unit.

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Background: Most patients hospitalized at intensive care units have a continuous infusion catheter in place for receiving drugs and solutions; nonetheless, blood sampling in these units is still performed through an invasive and painful venipuncture. However, it is possible to take blood from a peripheral venous catheter to obtain accurate laboratory test results and alleviate the suffering of patients.

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Background: Because of its nature, nursing is one of the stressful jobs. Abundant stressful factors existing in this job cause the occurrence of physical and mental disorders in nurses.

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Objectives: This study is to propose recommendations regarding glycemic control in intensive care in the post surgical patient.

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Background: Delirium is the most common neurological diagnosis with a high occurrence among patients hospitalized in intensive care units (ICUs). Nurses should be able to connect with these patients and improve the prevailing mood in ICUs. Qualitative research attempts to discover people’s views and thoughts and understand the depth of issues through their experiences. The present qualitative study aimed to explore ICU nurses’ experiences of care provision for delirious patients.

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Background: In intensive care units (ICU), there should be some more facilities and equipment such as ventilators, monitors, suction pumps, etc. These devices are equipped with an alarm system in their settings. Sometimes, too many alarms cause alarm fatigue among nurses and consequently would jeopardize the safety of patients. Therefore, the current study aimed at designing a tool to assess the alarm fatigue among nurses.

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Background and Aim: One of the most important problems of patients admitted to intensive care units (ICU) is their sleep quality. In these units, there are various visual and auditory discomfort factors that can negatively affect the outcome of the patient's treatment. The purpose of this study was to determine the effect of simultaneously using earplug and eye mask on the quality of sleep in hospitalized patients in the ICU.
Method: This study was performed on 73 patients who had been admitted to the ICU of Ghaem Hospital and Imam Reza Hospital in 2016 in Mashhad. Patients were randomly assigned to control (n = 37) and test (n = 36) groups. The test group used an earplug and an eye mask during their night's sleep. Patients' sleep quality was assessed by using Voran-Schneider-Halper's questionnaire. Data were analyzed using SPSS16 software.
Results: Independent t-test and Mann whitney U showed that before and after the intervention stage, no significant difference was observed between the test and control groups regarding the mean score of sleep quality. However, the results of Wilcoxon test showed a significant difference in the quality of sleep score in both groups before and after intervention (p <0.001).
Conclusion: In this study, simultaneous use of earplug and eye mask was effective in improving the quality of sleep in patients admitted to the ICU. Therefore, this technique can be used as a simple, low-cost, and effective method in helping patients to prevent complications from sleep disorders.
 
Keywords: Sleep quality, Earplugs, eye mask, Intensive care unit, patient

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Background and aim: The subjective workload is a significant stressor in nursing profession and the stress can lead to cognitive problems and occupational cognitive failure. However, the relationship between subjective workload and cognitive failure is ambigious. Therefore, this study was conducted to determine the relationship between nurses’ Subjective workload and occupational cognitive failure in intensive care units.
Methods: This analytical cross-sectional research was conducted on 176 nurses working in intensive care units of Rasht medical centers in 2017. Samples were selected using census method. The data collection tools consisted of personal and occupational data, standard questionnaires for subjective workload (NASA-TLX) and occupational cognitive failure (OCFQ). The data analysis was performed by the software of SPSS 21 and descriptive and inferential statistic tests of Mann-Whitney and Kruskal-Wallis, Spearman correlation.
Results: The majority of samples were female (93.2%) with a mean age of 35.85 ± 7.8, married (71%) and undergraduate (92.2%), ICU (71%), Formal employment (64.2%) with an average work record of 12.21 ± 7. 06 years (86.9%). Mean score and standard deviation for subjective workload was 59.95 ± 16.41 and for occupational cognitive failure 70.31 ± 17.06. There was a significant positive correlation between occupational cognitive failure and subjective workload (r = 0.272, p <0.001).
Conclusion: Considering the relationship between subjective workload and cognitive failure, the patient's safety and eventually the quality of care may be improved by designing strategies to reduce the subjective workload and considering its related factors in the planning of human resources employed in intensive care units.
 
Keywords: Intensive care units, Nursing staff, Workload

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Background and aim: Nausea, vomiting, diarrhea and constipation are some of the common problems of hospitalized patients. These problems are exacerbated by the hospitalization of patients in the Intensive Care Unit (ICU). The purpose of the present study was to evaluate the prevalence of nausea, vomiting, diarrhea, and constipation of hospitalized patients in the ICU.
Methods: This research was a cross-sectional study. In the study, 104 hospitalized patients in the ICU were selected through convenience sampling in a period of six months, from the 1^st September 2018 to the 1^st of March  of the same year, based on the inclusion criteria. Data were collected using demographic and nutritional status assessment questionnaires.  Data were gathered using demographic and nutritional status assessment questionnaires retrieved from a specific form in this regard from the Ministry of Health.
Results: Hospitalized patients in the ICU were evaluated for nausea, vomiting, diarrhea, and constipation. Among them, 50% had vomiting, 44.3% had nausea, 35.7% had diarrhea, and 12.7% had constipation.
Conclusion: Given the significant adverse nutritional outcomes of the hospitalized patients to the ICU, considering a standardized and condition-based plan may reduce the negative nutritional outcomes of these patients.

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Background and aim: Quality care providing is one of the main goals of health care services and a nurse is a team axis and plays a key role in this issue. Therefore, the aim of this study was to evaluate the quality of nursing care from nurses' point of view and its relationship with demographic and professional variables.
Methods: This research was a descriptive-analytic study that was performed by a demographic and standard Quality Patient Care Scale (QUALPAC) questionnaire which has 72 questions in terms of psychosocial, physical and communication dimensions based on a Likert scale. The sample consisted of 200 nurses who worked in the intensive care unit of Isfahan- Iran.
Results: According to the participant's viewpoints, the average quality of nursing care in patients was favorable in physical and communication dimensions (2.63 ± 0.29). It was also to some extent desirable in the psychosocial aspect (2.45 ± 0.28). Also, there was a significant relationship between age, experience, type of employment, amount of overtime working and the quality of nursing care (p <0.05).
Conclusion: Considering the significant relationship between professional characteristics and the quality of holistic nursing care, it is suggested that health managers adjust the amount of overtime hours and also take into account the experience of expert nurses in order to take an effective step in formulating necessary policies in improving the quality of nursing care.

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The incidence and prevalence of delirium in the intensive care unit (ICU) are extremely high. Generally, the incidence and prevalence of delirium in the hospitalized patients in ICU are 29-31% (1, 2) and 11-25% (3, 4), respectively. Each additional day with delirium increases a patient’s risk of dying by 10%. The incidence of delirium among mechanically ventilated patients compared to non-intubated patients is reported 45 to 87% more (5-8).  
Due to the high prevalence of delirium in hospitalized patients in the ICU, the many effects of delirium on the short and long term outcomes of patients, and the imposition of high costs on the health system; several studies have assessed the impacts of delirium to outcomes of patients and healthcare systems (8,9). Recently, a study looking at costs over 1 year following an episode of delirium, estimated that delirium is responsible for between $60,000 and $64,000 of additional health-care costs per patient with delirium per year; at national level, total direct 1-year health-care costs attributable to delirium might range from $38 billion to up to $152 billion nationally (9). The cost associated with delirium in mechanically ventilated patients in the United States of America is around 4–16 billion dollars per year (10) which is impacts of the delirium on the health system.
The short-term implications of delirium for hospitalized patients in ICU include prolonged hospital stay, functional decline during hospitalization, increased risk of developing a hospital-acquired complication, and increased admission to long-term care (11, 12).
Chronic cognitive impairment and different physical and psychological functional disability are among the long-term impacts for hospitalized patients in ICU (13).
In overall, it can be concluded that there are differences between the complications of Delirium incidence, both short and long term, in admitted patients to the ICU by sex, socioeconomic status, race, ethnicity, and even the degree to which one practices an organized religion (religiosity) (14).  
According to the definition, religiosity and spirituality are broadly defined as feelings, thoughts, experiences and behaviors that arise from searching for the “sacred,” with former implying group or social practices and doctrines, and the latter referring to personal experiences and beliefs (15, 16).   
It’s been reported that approximately 90% of Iranians (USA 84%) report religious affiliation, and 96% of Iranians (USA 82%) report religion as at least somewhat or very important in their lives (17, 18).
Several systematic reviews of the literature support a relationship between religiosity promoting improved health behaviors (19, 20) and lower all-cause mortality (21, 22).
Emerging evidence suggests that religiosity and spirituality are correlated with improved mental and physical health outcomes, including decreased rates of depression (23), anxiety, post-traumatic stress disorder, suicide, and coronary heart disease (24).
Despite the recognition of the impacts of the delirium occurrence and its high cost on the health system from one side, and the relationship between religiosity and the delirium event, which significantly improves the consequences of it, from other side (19-22), to the best knowledge of the researchers, Still, the study does not investigate the effect of religiosity and spirituality on the severity of delirium to determine whether different levels of religiosity and spirituality cause different levels of delirium in admitted patients to the ICU or the effects of medications, the environment of the ICU and so on …. without affecting the different levels of religiosity, there are different degrees of delirium? which brings up a chicken-or-the-egg conundrum.

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Background and aim: Ethics is an inseparable part of nursing duties body   and one of the most important factors influencing human behavior. In fact, ethics can be considered as one of the main factors in promoting  respect of patient' rights.
 Purpose: The purpose of this study was to investigate the ethical intelligence of nurses working in general and  intensive care units in Tehran's selected military hospital.
Methods: This descriptive-analytical study was  performed from  July until  November 2018.The study was conducted on 120 out of 1,200 nurses working in the hospital who were selected based on the Morgan sample size table and allocated to the general and intensive care units, 40 of which were in the intensive care unit and 80 in the internal and surgical units. Ethical intelligence of the samples was measured using the Lenik and Kiel moral intelligence questionnaire and then analyzed using SPSS 20 software.
Results: The inclusion criteria were at least one year of  job experience, at least a bachelor's degree in nursing and  aged  22 to 50 years. The samples consisted of 56 females and 64 males, of which 107 were married and 13 single, 12 had a master's degree and 108  bachelor's degree. The mean and standard deviation of nurses' moral intelligence was 75.25 (SD=8.47) and in general wards was 73.26 (SD=9.87) and in intensive care unit nurses was 77.25 (SD=7.07). The highest level among the four criteria of nurses' moral intelligence was honesty in the general and intensive care units with a mean of 79.62 (SD=11.22) which in the general unit 79.00 (SD=10.32) and in intensive care unit  80.25 (SD=12.12).The results showed that 77.5% of nurses were in good and higher level of moral intelligence.
Conclusion: The results indicate the importance and place of ethical teaching in nursing. The nurse's attitude  towards the patient, herself and her job can promote this profession. Therefore, today acquiring ethical knowledge and the ability to cultivate nurses' moral intelligence is one of the essentials in this profession. It is recommended to provide appropriate ethics training for nurses in the form of in-service courses. due to the difference in the nurses moral intelligence in the general and intensive care units, which indicates hospital managers pay more attention to the intensive care units, so managers need to have the same sensitivity and attention to general units as to intensive care units.

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Background and aim: Professional self-concept is an individual’s perception of self as a professional person which affects his/her thinking, role development and professional functions. Among various professions, some need higher levels of self-concept. The nursing profession has been considered to have a special status in this regard. Therefore, the present study was conducted to determine professional self-concept in nurses working in the Intensive Care Units (ICU) in the selected university hospitals of Tehran in 2018-19.
Methods: This study was a descriptive-analytical study which was performed on 540 nurses working in the ICU of selected university hospitals in Tehran. Sampling was done randomly. The instruments used in this study included the Demographic Information Questionnaire and the Quinn Professional Self-concept Questionnaire.
Results: The mean score of professional self-concept was 218/36±29/91. The highest and the lowest scores were respectively related to the dimensions of knowledge and leadership with the mean of 43/22±4/76 and 17/23±5/93. Pearson's correlation coefficient between all dimensions of professional self-concept was calculated. The significance level for all dimensions was 0.001. As a result, a significant relationship exists between these dimensions.
Conclusion: Although the ICU nurses gained relatively high scores in professional self-concept, especially in the knowledge dimension, however it was far from ideal. Also, these nurses gained the lowest scores in the leadership dimension which reveals the weakness of nurses in this context. To conclude, it seems more than necessary to train nurses in this field in order to increase their professional self-concept.
 
 
Keywords: Professional self-concept, Nurses, Intensive care units

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