Critical Care Nursing
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- ItemEVALUATION OF DOCUMENTATION QUALITY AND CLINICAL PERFORMANCE THROUGH REAL-TIME TABLET-BASED CARDIAC ARREST RESUSCITATION DOCUMENTATION(An-Najah National University, 2024-09-03) Talbishi, NouraldinBackground: Traditional paper-based resuscitation documentations are well known for their lack of accuracy, often failing to capture the requisite level of details needed for appropriate documentation of a rapid cardiopulmonary resuscitation (CPR). The objective of this study was to assess the sensitivity and time discrepancy of a real-time tablet-based cardiac arrest resuscitation documentation application compared to the traditional paper-based resuscitation documentation. Additionally, the study also assessed the effect of using a metronome on meeting the recommended number of compressions while performing CPR. Methods: The study was conducted at Bethlehem University's Clinical Simulation and Life Support Center and An-Najah National University's Life Support Training Center. Cardiac arrest situations were simulated during Advanced Cardiovascular Life Support (ACLS) training courses for which the study team (n = 72 participants) started a rapid ACLS scenario that consisted of 25 sequential steps/events that were based on the Adult Cardiac Arrest Algorithm of the American Heart Association (AHA). Each step/event was documented using the traditional paper-based resuscitation documentation method and the real-time tablet-based cardiac arrest resuscitation documentation application. The sensitivity and time discrepancy of the two methods in documenting CPR steps/events, ventricular fibrillation (VF), defibrillations/shocks, medication administrations, and return of spontaneous circulation (ROSC) were compared. Results: This study evaluates the effectiveness of a real-time tablet-based cardiac arrest resuscitation documentation application compared to the traditional paper-based method during Advanced Cardiovascular Life Support (ACLS) scenarios. The tablet-based method demonstrated significantly greater sensitivity in accurately documenting key resuscitation events, including CPR pauses, defibrillation, medication administration, and cardiac rhythms (p-values ranging from <0.001 to 0.031). Furthermore, time discrepancies in documenting 25 critical events were significantly reduced when using the tablet-based application (p < 0.001). Additionally, the use of a metronome was strongly associated with achieving the recommended number of chest compressions (p < 0.001). These findings suggest that the tablet-based system enhances the precision and timeliness of resuscitation documentation, potentially improving clinical outcomes in cardiac arrest management. Conclusions: The findings of this study showed that using the real-time tablet-based cardiac arrest resuscitation documentation application improved the accuracy, sensitivity, and timeliness of resuscitation documentation compared to traditional paper-based methods. Similarly, the use of a metronome improved meeting the recommended compression rates while performing CPR. These findings indicated that the use of digital tools can improve the quality of emergency care. The findings highlight the importance of integrating modern and innovative technologies in ACLS and CPR practices. Improving documentation practices can allow healthcare providers and decision-makers to identify and address local challenges in emergency care practice and improve the outcomes of the patients. Keywords: Cardiopulmonary resuscitation, Cardiac arrest documentation, Code sheet, Tablet applications
- ItemACIDOSIS AND URINE OUTPUT AS INDICATION FOR STARTING CONTINUOUS RENAL REPLACEMENT THERAPY AMONG ACUTE KIDNEY INJURY PATIENTS IN INTENSIVE CARE UNIT: RETROSPECTIVE STUDY AT AL-AHLI HOSPITAL IN HEBRON(An-Najah National University, 2024-05-23) Aramin, OsamaBackground: Acute Kidney Injury has a substantial global impact , with an estimated 13 million people affected annually. Acute kidney injury has been reported in 30–60% of hospitalized patients and is prevalent in critically ill individuals and 5– 20% of critically ill patients in the intensive care unit . Up to 4.9% of severely ill patients may require renal replacement therapy. In the last decade the absolute incidence of acute kidney injury has risen, with episodes occurring in. The study aims to investigate acidosis and urine output as indicators for starting continuous renal replacement therapy among acute kidney injury patients in the intensive care unit at AL-Ahli Hospital in the west bank of Palestine . Methods: This Research utilized a Quantitative Retrospective and Descriptive method. The Purposive sampling technique was employed to select participants. The study included all patients diagnosed with acute kidney injury who underwent dialysis all patient with vasopressor , regardless of their age and gender. Demographic data, the presence of comorbidities, the indication for continuous renal replacement therapy, vital signs , urine output, and inotropic , laboratory findings was collected before and after the commencement of continuous renal replacement therapy . Results: The medical records of 96 acute kidney injury patients who received continuous renal replacement therapy between April 2021 -April 2023 was reviewed , was the two -third of patients with comorbidity disease .The mortality rate was 28.1% was 69.8% of patients on mechanical ventilation and all patients was anuria , percentage of males was 56.3% and 43.8% of females , the percentage of survivor patients was 56.5% male and 43.5% of females , went on to receive either chronic hemodialysis or normal kidney function . Conclusion : The most diagnosis for patient on continuous renal replacement therapy commencement septic shock , and the most indication to commencement acidosis and anuria , was the anuria, acidosis, overloaded fluid, & anuria indications was more likely to have survival , comorbidity disease is higher mortality patients on mechanical ventilation less likely to survive , decrease serum creatinine and blood urea nitrogen was not associated with increased mortality .
- ItemTHE EFFECT OF EARPLUGS AND EYE COVER ON SLEEP QUALITY FOR ICU PATIENTS(An-Najah National University, 2024-07-03) Hamarsheh, SajaBackground: Patients in Intensive Care Units had poor sleep quality due to a variety of conditions that could disturb their sleep. Intensive Care Units(ICUs'), characterized by high levels of noise, hinder sleep and can negatively impact the healing process of patients undergoing intensive care. Aim: To assess the effects of earplugs and eye covers on the quality of sleep and frequency of sleep disturbances among patients in critical care units. Design and methods: Intensive Care Unit and Cardiac Care Unit patients participated in a quasi-experimental study using a pre- and post-test methodology. Study sample was recruited conveniently in Intensive Care Unit and Cardiac Care Unit from four hospitals, with a total sample of (100) participants. 50 participants were selected as a control group, and the other 50 as an intervention group. Data in both groups was collected pre and post intervention by 'Richards Campbell Sleep Questionnaire' and Pittsburgh sleep quality. Result: Significant statistical variances were observed between the groups. Nonetheless, the effects were moderate across various sleep parameters, indicating that patients in the intervention group experienced enhanced sleep quality compared to those in the control group. Patients expressed their satisfaction and comfort towards the efficacy of earplugs and eye covers in improving sleep quality. Both groups identified noise, medical equipment, and nursing activities as factors contributing to disturbances of sleep patterns. Demographically, the results of intervention and controlled group were not significant, with only employment scoring statistically high, indicating that there is a significant difference at baseline between control and intervention groups, χ2(2) = 9.665, p = .008, with a mean rank RCSQ score of 41.23 for student, 44.81 for unemployed and 63.24 for freelance group, sleep were significantly higher in the intervention group compared to the control group (p < 0.05) in the Mann-Whitney. The control group showed a statistically significant difference (278 ± 177.14). statistically significant difference from pre-intervention to post-intervention (p < 0.05) in Wilcoxon signed-rank. Conclusion: Earplugs and eye covers were simple and inexpensive devices that can be used to reduce noise and light exposure, ensuring the quality of sleep in critical care units. Sleep Sounds were essential for acutely ill clients to recover quickly. Keywords: Sleep quality, Intensive care unit, Earplugs, Eye cover.
- ItemMORTALITY IN HEMODIALYSIS PATIENTS AND THE LEADING CAUSE OF DEATH IN A SINGLE CENTER AT THE NORTHERN OF WEST BANK: A RETROSPECTIVE COHORT STUDY(2022-12-21) Malek Isam Awni AbdelghaniBackground: Currently, there were 5 to 7 million patients who have end-stage renal disease (ESRD) that need renal replacement therapy. This study was conducted to determine the mortality rates among hemodialysis patients at An-Najah National University Hospital which is one of the main referral centers in the north of the West Bank of Palestine. The study also aimed to describe the causes of death among this group of patients. Methods: This study used a quantitative correlational retrospective cohort design. The study included all adult patients with ESRD who underwent hemodialysis irrespective of their gender, and duration of dialysis. Demographic variables, etiology of the ESRD, presence of comorbidities, and laboratory findings of the patients were collected. Results: Medical records of 348 ESRD patients who were on hemodialysis between January 2017 and December 2021 were reviewed. Of the 348 ESRD patients, 95 patients died giving an overall mortality rate of 27.3%. Of the patients who died, 68.4% were male and 91.6% were dialyzed for 1-3 years. Cardiovascular disease was the leading cause of death (43.2%) among the patients in this study. Diabetic nephropathy was the leading cause of ESRD (77.9%) among the patients who died in this study. Of the patients who died in this study, 60% had diabetes mellitus and hypertension and 88% had hypoalbuminemia. Mortality was associated with older age and smoking. Conclusions: The mortality rate among patients on hemodialysis was within the range of mortality rates reported in the regional studies. Cardiovascular disease was the leading cause of death among the patients in hemodialysis. More studies are still needed to investigate the effects of manipulating some modifiable risk factors on the mortality rates among hemodialysis patients in Palestine. Keywords: Chronic kidney disease; End-stage renal disease; Hemodialysis; Mortality.
- ItemHEPARINIZATION VERSUS SALINE FLUSH OF CENTRAL VENOUS CATHETER (CVC) LUMENS IN CRITICAL CARE UNIT PATIENTS IN LARGE TERTIARY HOSPITAL(2022-12-28) Enas Abed Al-Kareem TalebBackground: The central venous catheter (cvc) has a risk of complications, including catheter thrombosis. To prevent this thrombosis, flushing of CVC is needed. There are several methods for flushing (CVC): the first one is heparin with saline after each use while the second method is saline flush. Objectives: To assess the effectiveness of intermittent flushing of normal saline versus heparin to prevent occlusion in long‐term central venous catheters among adult patients in the ICU of Large Tertiary Hospital. Methodology: Randomize Control trial (RCT) design was used in this study. The sample was selected from all patients who were admitted to the ICU department of An-Najah Hospital during the period of August 2020 to October 2020 and have CVC. Patients were selected in a convenience method, and 53 patients agreed to participate in the study. These patients were distributed randomly into two groups; an experimental group (n =26 patients) and a control group (n =27 patients). The experimental group was given flush (a combination of heparin and normal saline), and the control group was given a flush with (normal saline only). To monitor the two procedures, the researcher developed a Check list that included demographic data, lab values, hemodynamic, Patency and complication of CVC. The researcher was able to fill the checklist for every patient. Results: The results showed that coagulation profile (PTT) was less than 35 seconds at admission for experimental group (76.9%) versus control group that got (48.1%) at significant level of P value; (0.031). For easy patency of CVC, the experimental group got (69.2%) which was higher than control group; (37%) while in moderate and difficult patency, the experimental group had less value than the control group (40.7% VS 26.9) and (22.2% VS 3.8%) respectively, at significant level of P value of (0.035). No differences were noticed between the experimental group and the control group in occurrence of complication such as discharge color around CVC, Swab culture result, Oozing from the CVC site. The study showed that dressing daily was for the control group (96.3%) while it was weekly for the experimental group (76.9%). Conclusion: There was a significant difference in the coagulation profile only at admission (p value is 0.031) and significant in patency (p value is 0.035). CVC of the experimental group (combination N/S with heparin group) showed easier patency than the control group (normal saline group), while there was no significant difference in the complications between the two groups. Recommendation: Nurses working at the ICU units should be oriented about the use of normal saline (0.9%) alone without heparin to flush CVC for adult patients. The benefit of this method should be emphasized as to decrease cost of heparin use, and to avoid any adverse effects with heparin use Keywords: Central Venous Catheter (CVC), Heparin, Normal Saline (NS),