Critical Care Nursing
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- ItemEARLY VERSUS LATE TRACHEOSTOMY IN THE MECHANICALLY VENTILATED CRITICALLY ILL PATIENTS: A RETROSPECTIVE MULTICENTER COHORT STUDY IN PALESTINE(An-Najah National University, 2025-09-02) Abu Tammam, AbdelrauofBackground: Prolonged mechanical ventilation (PMV) is a particularly common reason for tracheostomy in patients hospitalized to intensive care units (ICU). The operation is classified as "early" or "late" based on the date of its execution relative to the start of mechanical ventilation (MV). Although the evidence for early versus late tracheostomy varies, early tracheostomy has been linked to shorter hospital stays and lower mortality rates. No previous studies in Palestine have compared or assessed the optimal timing of tracheostomy, although some hospitals follow an ET protocol for expected PMV patients. Aim: To compare the clinical outcomes of early vs late tracheostomy for mechanically ventilated critically ill patients in the ICU. Methods: This retrospective multicenter observational cohort research was carried out in Palestine from January 2023 to December 2024. Patients who had elective tracheostomies were divided into two groups: early tracheostomy (ET), which was performed during the first 10 days of intubation, and late tracheostomy (LT), which was performed beyond the tenth day. The major outcomes assessed were mortality, duration of MV, length of stay in the ICU and hospital, and incidence of ventilator-associated pneumonia (VAP). These outcomes were evaluated and compared among groups, both overall and stratified by APACHE II scores. Results: About 66 patients were included in the study, 37 in the ET and 29 in the LT. ET was associated with significantly lower mortality (P = 0.033), shorter duration of MV (P <0.001), and reduced length of ICU (P < 0.001) and total hospital stays (P <0.001). VAP rates were not significantly different (P = 0.083). In patients with APACHE II ≤ 20, ET significantly improved all outcomes except mortality (P = 0.405). In patients with APACHE II > 20, ET significantly reduced the total duration of MV (P = 0.009), length of ICU and hospital stays (P = 0.037; P = 0.035, respectively) while having no significant impact on mortality (P = 0.238), duration of post-tracheostomy MV (P = 0.236), and VAP (P = 0.474). Conclusion: ET appears to be associated with improved outcomes compared with LT, particularly in lower-risk patients.
- ItemKNOWLEDGE, ATTITUDE amp; PRACTICE TOWARD NEONATAL PAIN ASSESSMENT AND MANAGEMENT IN NICUS OF TWO HOSPITALS IN WEST BANK : EVALUATION OF EDUCATIONAL SESSIONS FOR NICU NURSES(An-Najah National University, 2025-08-12) Abu Asba, LameesIntroduction : Neonatal pain is a critical concern in NICUs, as unmanaged pain can lead to serious short- and long-term developmental consequences. Despite growing awareness, effective pain assessment and management remain inadequate. This study highlights the importance of addressing neonatal pain and explores the key challenges faced by NICU nurses, including limited knowledge, lack of standardized assessment tools, insufficient training, and heavy workloads. Overcoming these barriers through targeted education, clear protocols, and institutional support is essential to improving neonatal outcomes and ensuring high-quality, evidence-based care. Aim : To investigate the knowledge, attitudes, and practices of NICU nurses in the West Bank, as it has a limited number of studies conducted in this region toward neonatal pain assessment and management, as well as to identify the barriers that hinder effective pain assessment & management in this population. In addition, it aims to evaluate the effectiveness of educational sessions provided to these nurses, with the goal of improving clinical practice performance and neonatal pain care outcomes. Method : This study employed a quasi-experimental pre-test–post-test multicentre design, conducted in two hospitals in the Jenin area of the West Bank—Al-Khalil Suleiman Governmental Hospital and Al-Razi Private Hospital—with a voluntary sample of 50 NICU nurses. Data were collected using a self-administered questionnaire covering demographics, knowledge, attitudes, practices, and perceived barriers related to neonatal pain assessment and management. Educational sessions were held over two days, combining lectures and practical training on neonatal pain physiology, assessment tools, and management strategies. The questionnaire was re-administered in two phases: the first, three days post-intervention (assessing knowledge and attitudes), and the second, three months later (full questionnaire), to evaluate both immediate and long-term effects of the sessions. Results : The study demonstrated significant improvements in NICU nurses’ knowledge, attitudes, and practices regarding neonatal pain assessment and management following educational sessions. Knowledge increased from 52% to 82% immediately post-intervention and remained at 74.6% after three months, while attitude scores rose from 63.4% to 87.9%, then stabilized at 73.3%. Practice scores improved from 27.5% to 52.4%, and perceived barriers decreased from 69.8% to 56%, with personal and organizational barriers also showing notable reductions. A positive correlation was found between knowledge and attitude, and a statistically significant negative correlation (r = –0.372, p = 0.008) was observed between knowledge and barriers, indicating that increased knowledge helped reduce perceived barriers. No significant relationships were found between demographics and knowledge, attitudes, or barriers, except for practice, which was significantly associated with education level—diploma-holding nurses scored higher than those with a baccalaureate or higher degree. Conclusion : This study highlights the positive impact of targeted educational interventions on improving NICU nurses’ knowledge, attitudes, and practices regarding neonatal pain assessment and management. The findings demonstrate that enhanced knowledge not only fosters more positive attitudes but also helps reduce perceived barriers in clinical practice. While demographic variables showed limited influence, education level was significantly associated with practice outcomes. These results emphasize the importance of continuous professional development and structured training programs to empower nurses and ensure more effective, evidence-based neonatal pain care.
- ItemTHE EFFECTIVENESS OF USING THE EDUCATION PROGRAM ON INTENSIVE CARE NURSES’ KNOWLEDGE TO PREVENT MEDICAL DEVICE-RELATED PRESSURE INJURIES (MDRPIS)(An-Najah National University, 2025-06-30) Kharoosheh, SuhailaAbstract Background: Using devices intended for diagnostic or therapeutic purposes can lead to pressure injuries related to medical devices. In most cases, the pressure injury that results fits the device's shape or pattern. Aim: The purpose of the study is to assess how well the educational program has improved the knowledge of intensive care nurses about preventing medical device-related pressure injuries (MDRPIs). Design: A quasi-experimental research design. Setting: The study was carried out in a number of An-Najah National University Hospital's (NNUH) intensive care units (ICUs) in Nablus, Palestine. Subjects: A total of 74 ICU nurses take part in the study. Instruments: Data were gathered using two main instruments: 1. The Nursing form was utilized to acquire professional and demographic data. A self-report survey called the Medical Device-Related Pressure Injures Knowledge Questionnaire (MDRPI-KQ) evaluated nurses’ knowledge and comprehension of MDRPI and various common measures to prevent it from occurring. Results: The nurses’ knowledge improved significantly from 68.2% pre-intervention to 94.9% post-intervention across all subdomains (p < 0.05). Indicating a statistically significant improvement across all knowledge domains, which include knowledge, risk factors, staging, prevention, and treatment. Conclusion: It was demonstrated that the MDRPI prevention and management training program was a successful instrument for raising nurses' awareness and knowledge of the problem while also equipping them with current, evidence-based techniques and expertise. Recommendation: Institutions should adopt ongoing educational programs, establish MDRPI-specific clinical protocols, and promote evidence-based training for ICU staff.
- ItemCOMPARISON OF THE OUTCOMES BETWEEN PERCUTANEOUS CORONARY INTERVENTION ALONE AND PHARMACOINVASIVE CORONARY INTERVENTION AMONG ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI) PATIENTS(An-Najah National University, 2025-02-03) Ma’ali, Basel Khairy AliBackground: Myocardial infarction is among the most diagnosed cardiological diseases in the whole world and in Palestine, and is managed mainly by invasive interventions to control or treat coronary artery occlusion, while some centers add tissue plasminogen activator to the plan in what so called pharmacoinvasive approach. The incidence of postoperative complications is inevitable, and therefore, the aim of the current study is to identify the most common complications compared between two myocardial infarction management approaches (percutaneous and pharmacoinvasive coronary interventions) in two tertiary centers in Ramallah and Nablus, and determine the most common risk factors associated with the differences between them. Methodology: The study utilized retrospective cohort design on a randomized sample of 160 adult (30 – 75 years old) patients who were admitted to intensive care cardiology departments of Palestine Medical complex (for pharmacoinvasive approach) and An-Najah National University Hospital (for percutaneous coronary intervention approach). The researcher used a data sheet that was developed based on previous literature, and data were analyzed using software. Results: Patients who underwent percutaneous coronary intervention (n = 82, 51.2%) were significantly older (mean = 59.8 ± 9.7 vs 56.2 ± 12.7) than pharmacoinvasive (n = 78, 48.8%). Catheter insertion site was mostly radial in percutaneous coronary intervention patients (95.1%) compared to pharmacoinvasive (15.4%), with no significant difference in MI location. Patients with percutaneous coronary intervention patients showed more significant decrease in white blood cells, low-density lipoprotein, high-density lipoprotein, triglyceride and heart rate, with more significant increase in troponin-I, and less increase in sodium, compared to pharmacoinvasive patients (p-value < 0.05) between pre- and post-operative phases. All postoperative complications, except for upper gastrointestinal bleeding, and mortality rate were significantly higher among pharmacoinvasive patients (p-value < 0.05). Lastly, significantly more postoperative complications were found among patients with dyslipidemia, valve regurgitation and cardiac hypokinesia. Conclusion: Patients who were treated with pharmacoinvasive approach showed higher postoperative complications and 30-day mortality rate. More research is needed in this area of cardiology management in Palestine. A prospective design is also recommended to be conducted for this topic in the future research.
- ItemSTRESS, BURNOUT, AND JOB SATISFACTION AMONG CRITICAL CARE NURSES IN EAST JERUSALEM HOSPITALS(An-Najah National University, 2024-12-17) Darabee, AymanBurnout, stress, and job dissatisfaction are prevalent among critical care nurses and impact both their well-being and patient care. This study examines these issues in hospitals in East Jerusalem. To assess Stress, Burnout, and Job Satisfaction among Critical Care Nurses in East Jerusalem Hospitals. A descriptive, cross-sectional, was conducted across four major hospitals in East Jerusalem: Al-Makased Hospital, Saint Louis - French Hospital, Augusta Victoria Hospital, and Red Crescent Society Hospital. A sample of 195 critical care nurses was surveyed using the Maslach Burnout Inventory (MBI), Job Stress Scale (JSS), and Mueller/McCloskey Nurse Job Satisfaction Scale (MMSS). Data were collected from May 1, 2024, to July 30, 2024, and analyzed using SPSS 25. The study involved 195 ICU nurses and revealed significant levels of moderate burnout (79%) and stress (75.9%), alongside pervasive job dissatisfaction (mean = 2.9/5), driven by factors such as advanced age, higher patient loads (>3 patients), lower income (<5000 NIS), and limited autonomy. Burnout and stress exhibited strong positive correlations (r = 0.552), while both inversely correlated with job satisfaction (r = -0.485 to -0.496), highlighting their interconnectedness. Nurses in leadership roles reported lower burnout/stress, emphasizing structural support as a protective factor. Findings underscore the urgent need for targeted interventions, including workload management, equitable compensation, and enhanced decision-making involvement, to mitigate occupational strain and improve retention in high-pressure ICU environments. This study underscores the pervasive occupational challenges faced by ICU nurses in East Jerusalem, with 79% experiencing moderate burnout and 75.9% reporting stress, alongside widespread job dissatisfaction (mean = 2.9/5). Significant predictors included high patient loads (>3 patients), low income (<5000 NIS), and limited autonomy. Leadership roles emerged as protective, highlighting the importance of structural support. These findings emphasize the urgent need for systemic interventions, such as equitable workload distribution, fair compensation, and participatory decision-making, to alleviate occupational strain. Addressing these issues is critical not only for improving nurses’ well-being and retention but also for safeguarding the quality of critical care in resource-constrained settings like East Jerusalem. Future policies must prioritize nurse-centric reforms to foster resilient healthcare systems in high-stress environments.