Critical Care Nursing

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https://hdl.handle.net/20.500.11888/15995

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    COMPARISON 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 Ali
    Background: 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.
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    STRESS, BURNOUT, AND JOB SATISFACTION AMONG CRITICAL CARE NURSES IN EAST JERUSALEM HOSPITALS
    (An-Najah National University, 2024-12-17) Darabee, Ayman
    Burnout, 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.
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    THE IMPACT OF ABCDE BUNDLE IMPLEMENTATION ON MECHANICALLY VENTILATED PATIENTS OUTCOMES AT ICU IN HEBRON GOVERNMENTAL HOSPITAL
    (An-Najah National University, 2024-10-15) Sawsan, Al-Sarahinah
    Background: ABCDE bundle implementation is an evidence based and recommended practice to adequately manage mechanically ventilated patients, but application of this bundle in environment with shortage of resources and has no specific protocol to deal with mechanically ventilated patients is unknown Objective: to measure the impact of ABCDE bundle implementation on mechanically ventilated patients' outcomes: ICU length of stay, ventilator free days, delirium occurrence and duration, and early mobility at ICU in Hebron Governmental Hospital. Methods: a prospective-quasi experimental study was conducted between December-2022 to March-2024, in which 76 patients on mechanical ventilation were divided into two groups. In the pre ABCDE bundle (n=36), traditional approach to deal with mechanically ventilated patients was used. In the post ABCDE bundle group (n=40), ABCDE bundle was used. Those outcomes were compared between both groups: ICU LOS, VFDs, delirium occurrence and duration, and early mobility. Results: the results showed no statistically significant differences between two groups regarding ICU LOS, VFDs (P=0.88, P=0.9) respectively. The median duration of MV was less in the intervention group 3 days in comparison to 3.5 days in control group (P=0.378). The percentage of early mobility was higher in ABCDE group (P=0.242). ABCDE group was more lightly sedated than non-ABCDE group who was more deeply sedated. Delirium occurrence and duration were less in ABCDE group (P= 0.362, P=0.22) respectively. Restraints use was significantly decreased in group who adapted bundle (20.5% in intervention group versus 44.4% in control group) with P value=0.008. Conclusion: ABCDE bundle helped in making mechanically ventilated patients more awake and oriented to environment and decreased using of restrains among them. It also minimized the use of benzodiazepines to half. Other outcomes like ICU LOS, VFDs, delirium occurrence and duration, and early mobility needs more research with larger sample size and more effective adherence to bundle. This study gave background for the future research to implement this bundle in environment with shortage of resources. Keywords: ABCDE bundle, ICU LOS, mechanical ventilation, delirium, early mobility.
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    EFFECT OF WARMED VERSUS ROOM TEMPERATURE FLUID ADMINISTRATION ON POSTOPERATIVE HYPOTHERMIA AND SHIVERING AMONG ELECTIVE ABDOMINAL SURGERY PATIENTS
    (An-Najah National University, 2024-09-26) Hamad, Ahmad
    Background: Intraoperative hypothermia is one of the common complications associated with significant postsurgical complications and negative outcomes. The aim of this study to evaluate the effect of delivering warmed intravenous fluid to the patient undergoing elective abdominal surgery, on minimizing hypothermia and shivering. Methods: Interventional research was done to assess the impact of administering warm intravenous fluids on reducing post-anesthesia shivering and hypothermia in patients undergoing elective abdominal surgery upon entering the operating room. The study was conducted in one of the main surgical hospitals in the West Bank, Palestine. In this study, a total of 118 elective abdominal surgery patients were assessed for eligibility. Of those, 90 were randomized into the intervention (n = 45) and control (n = 45) groups. Of those, half (50%) received warmed fluids (intervention group) and half (50%) received unwarmed fluids. The temperature of the elective abdominal surgery patients was assessed preoperatively, intraoperatively, upon admission, and 30 min after admission to the post anesthesia care unit. The Bedside Shivering Scale was used to evaluate elective abdominal surgery patients' shivering levels. Results: The elective abdominal surgery patients in the control group had significantly lower heart rate (p = 0.044), intraoperative body temperature (p = 0.003), and more moderate and severe Bedside Shivering Scale ratings (p = 0.043) compared to the patients who received warmed intravenous fluids. On the other hand, the elective abdominal surgery patients in the control group lost significantly more (p = 0.020) blood compared to the elective abdominal surgery patients in the intervention group. At admission to the post anesthesia care unit, the elective abdominal surgery patients in the control group had significantly lower heart rate (p = 0.046), body temperature (p = 0.018), and more moderate and severe Bedside Shivering Scale ratings (p = 0.036) compared to the elective abdominal surgery patients who received warmed intravenous fluids. Similarly, 30 min after admission to the post anesthesia care unit, the elective abdominal surgery patients in the control group had significantly lower heart rate (p = 0.048), body temperature (p = 0.031), and more moderate and severe Bedside Shivering Scale ratings (p = 0.018) compared to the elective abdominal surgery patients who received warmed intravenous fluids. Conclusions: Overall, the provision of heated intravenous fluids effectively decreases the occurrence of hypothermia and shivering in elective abdominal surgery patients who are having clean open abdominal surgery. This simple but impactful technique improves elective abdominal surgery patients outcomes, shortens recovery time, and lowers the occurrence of surgical site infections. Introducing the use of heated intravenous fluids in surgical procedures might enhance the quality of care during the perioperative period, emphasizing the significance of this intervention in improving elective abdominal surgery patients safety and comfort.
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    PREVALENCE, PREDICTORS, AND OUTCOMES FOR ST- SEGMANT ELEVATION MYOCARDIAL INFARCTION PATIENT UNDERGOING PERCUTANEOUS CORONARY INTERVENTION
    (An- Najah National University, 2024-09-12) Alqassarweh, Haneen
    Background: Various factors such as age, gender, smoking, and underlying conditions including diabetes mellitus (DM), chronic kidney disease (CKD), ischemic heart disease (IHD), and hypertension (HTN) are widely recognized as significant risk factors for patients experiencing ST-segment elevation myocardial infarction (STEMI) and underwent percutaneous coronary intervention (PCI ). Methods:This quantitative retrospective cohort study was conducted at Ibn Sina Specialized Hospital. It involved 278 adult patients diagnosed with ST-segment elevation myocardial infarction (STEMI), aged between 18 and 70 years, who underwent percutaneous coronary intervention (PCI). Data were obtained from patient files post-PCI, extracted from the hospital's computed information system, with approval from the institutional review board (IRB) of An-Najah National University. Results: Out of 278 patients, 71.2% were males and 28.8% were females. The majority (96.4%) were over 40 years old. Significant differences were found in history of CKD, smoking, and average levels of pre- and post-catheterization hemoglobin and creatinine (p < 0.05). Gender, smoking, history of DM, HTN, and CKD significantly different with average levels of hemoglobin, creatinine, and troponin (p < 0.05). CKD, IHD, previous CABG, arterial access, and pre- and post-catheterization creatinine, pre-catheterization troponin, and post-catheterization hemoglobin levels showed significant differences with cardiac arrest (p < 0.05). Femoral artery catheterization resulted in higher hematoma rates than radial artery (12.5% vs. 0%, p > 0.001). Diseased right coronary artery and femoral artery catheterization were associated with higher arrhythmia rates. Conclusion: STEMI patients underwent PCI are at risk of complications like hematoma, arrhythmias, and cardiac arrest. Monitoring and early management are crucial, especially for patients over 40 years old, males, smokers, and those with comorbidities like DM, HTN, CKD, and IHD. According to the finding of the present study, the prevelance of STEMI in people over 40 years and less than 70 years old were( 69.4% vs 3.6%) repectively. Therefore, based on the result of the studies that have been reviewed and included in the meta- analysis , the high prevelance of STEMI was reported to be higher in male individual more than 70 years , which is considered a warning for health policymakers regarding the important of this age for diagnosis and screaning procedures of STEMI.