Background: Intubated patients experience an intensified need to communicate while their ability to do so is compromised as the endotracheal tube prevents speech which creates patient agitation.Aim: To determine the impact of using augmented alternative communication methods on outcome of intubated COPD patients.Patients and methods: Sixty male COPD intubated patients at the pulmonary critical care unit Mansoura University hospital were randomly assigned into two groups of 30 patients for each. The control group involved patients receiving the routine nursing communication practices while the study group involved patients who utilized modified communication board and paper/pen as an augmented alternative communication methods. Unconscious patients, visual and/or hearing impairment were excluded. Patient satisfaction questionnaire (PSQ), Patient Communication level, duration of intubation and mortality were adopted as endpoints.Results: Based on PSQ, 10% in the study group were very dissatisfied compared to 53.33% in the control group the difference was statistically significant. On the other hand, 40% in the study group were very satisfied compared to 6.66% in the control which was a statistically significant increase p < 0.001. However, the mortality did not differ significantly in both groups 16.66% in the control group compared to 13.33% in the study group.Conclusion: Alternative communication methods can improve the level of satisfaction and decrease distress but it did not change mortality in intubated COPD patients.

Introduction: Daily bed-baths are usually provided for most critically ill patients to improve patient hygiene, promote comfort and improve health outcomes. Critically ill patients are at greater risk for skin colonization and infection with multidrug-resistant organisms. Therefore, it is important to provide critically ill patient with effective personal hygiene especially bed-bath as poor hygiene may increase the risk of infection. The decision for bed-bath depends on the judgment of the caring nurse. The aim of this work was to describe bed-bath practices in intensive care units. Methods: A descriptive design was used. Sixty intensive care unit nurses were involved. Tool: "Bed-bath practices of critically ill patients' assessment sheet" was used to collect data. Results: More than three quarters of nurses, 79% had improper bed-bath practices. The gap for safe bed-bath practices between nurses' current bed-bath practices and the bed-bath evidence-based recommendations is wide (83%). Nurses' self-reported reasons that hinder safe bed-bath practices were financial resources, followed by lack of equipment, no policy, lack of knowledge, and workload. Conclusions: Although, bed-bath is a routine nursing procedure, critical care nurses in the current study had poor skills and knowledge regarding it. The factors affecting bed-bath practice are financial resources, lack of equipment, no policy, lack of knowledge and workload. In-service training program should be conducted for nurses regarding putting priority of nursing care, determining timing and frequency for the bed-bath.

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Background: Patient safety is the cornerstone for better quality health care and nursing education. There is limited evidence about how patient safety is addressed in healthcare professional curricula and how organizations develop safe practitioners.Aim: To assess the practices and perception of nursing students regarding the safety of critically ill patients.Materials and methods: Participants of this descriptive correlation exploratory study were 100 nursing students conveniently from the students enrolled in Critical Care Nursing course during academic year 2013-2014 in faculty of nursing, Alexandria University. The study was conducted in the critical care units affiliated to Alexandria Main University Hospital namely (Unit I, Unit III, and Triage). The first tool was Critical Care Practices of Safety Measures Observational Checklist and the second tool was Students’ Unsafe Clinical Practices Perception questionnaire.Results: It was found that 49% of the nursing students had poor perception regarding their unsatisfactory clinical performance. In addition, 55% of the nursing students have poor perception regarding their poor documentation. Furthermore, 44% of them have poor perception regarding lack of clinical educators’ role competency.Conclusions: Nursing students’ perception was poor regarding their clinical performance, cognitive performance and critical thinking skills and documentation. In addition, nursing students reported that they have poor perception regarding nurse educators’ role competency. Therefore, nursing curriculum should incorporate concepts and principles that guide nursing students in developing caring, safe, competent and professional behavior and should be developed for the nursing students based on the WHO patient safety topics which will focus on patient safety.

Background: Central venous pressure (CVP) monitoring remains in common use as an index of circulatory filling and cardiac preload. Positive end-expiratory pressure (PEEP) in mechanically ventilated patients can affect CVP via increasing intra-thoracic pressure. Critical care nurses should be able to measure the CVP competently and identify the factors affecting its readings. Aim: The current study was conducted to determine the effect of PEEP on the CVP readings in mechanically ventilated patients. Methods: a descriptive design used in this study. A convenient sample of 200 adult critically ill patients of both sex, hemodynamically and respiratory stable, having a central venous catheter (CVC) in place, and attached to a mechanical ventilator and pulse oximeter were included in the study. The patient's baseline CVP was recorded while the patient connected to the mechanical ventilator, then the patients were temporary disconnected from the mechanical ventilator and the CVP measured again without the effect of PEEP. Results: About 40% of the study sample aged 45 to 64 years, 52.5% were males, 50 % suffered from respiratory disorders, and 49% were overhydrated. Eighty eight percent of the study sample was on PEEP levels between 5 to < 10 cmH 2 O. The CVP readings while the patients connected to MV were higher than CVP reading while the patients without PEEP, but these differences were not significant. Conclusion: CVP readings are not significant affected by the PEEP up to 15 cmH 2 O. The CVP can be reliably measured while patients are connected to MV. Recommendations: Measurement of CVP can be obtained while the patient is connected to MV.

Background: Life-threatening problems are risks for critically ill patients. Moreover, they need complex care with carful coordination. In addition, nutritional support considered as fundamental aspect of a standard care of critically ill patients. Objectives: We aimed at evaluating the abdominal massage effect on gastrointestinal outcomes of critical ill patients with enteral feeding. Methods: Quasi-experimental research design was used in this study. The Swedish massage technique for abdomen was carried out twice daily for five consecutive days by the trained researcher. A convenience sample of 60 critically adult males with enteral feeding participated voluntarily in the study. Results:The results of this study revealed that, gastric residual volume was low with the study group than the control group during intervention period after abdominal massage. Also, a significant difference was noticed in last three days of the intervention between the study and control groups. Moreover, it was indicated that abdominal distension, vomiting, and constipation were low with the study group than the control group during the five consecutive days of intervention. Conclusion:This study provides promising evidence that massage of abdomen can be used with entirely fed critically ill patients to improve their gastrointestinal outcomes. This leads to a reduction in residual volume of gastric, distension of abdomen, constipation, and vomiting.

Background and objective: Cognitive recovery after severe traumatic brain injury (TBI) is the biggest challenge facing the critical care nurses (CCNs). Several studies have been reported that the majority of CCNs are concerned with providing conventional nursing practices to severe TBI patients. These practices are directed to stabilize patients’ status rather than to enhance cognitive recovery after TBI. Application of integrative nursing practices for TBI patients can help in enhancing cognitive recovery. Aim: This study aimed to determine the effect of integrative nursing practices on cognitive recovery among severe traumatic brain injury patients.Methods: A quasi experimental research design was utilized. A convenience sample was conducted on 60 adult patients suffering from severe TBI who admitted to the intensive care units of Alexandria Main University Hospital. Patients were assigned into study group (30 patients) and control group (30 patients). One tool was used for data collection namely “Cognitive Recovery Assessment Tool”. This tool was used to assess recovery of cognitive function domains. It consists of level of consciousness using Full Outline of Un-Responsiveness (FOUR) score, level of cognitive functioning using Rancho Los Amigos (RLA) scale and basic cognitive sensory recovery assessment using Western Neuro Sensory Stimulation Profile (WNSSP) scale.Results: The implementation of integrative nursing practices for the study group was associated with statistically significant positive effects. Patients in the study group showed higher means of consciousness revealed by FOUR score and cognitive function revealed by RLA scale. The basic cognitive sensory recovery revealed by WNSSP scale in the study group was also significantly improved.Conclusions: Implementation of integrative nursing practices has been shown to enhance cognitive recovery among severe TBI patients. Thus, it is recommended for use in a nurse’s daily routine of care for severe TBI patients.

Background: Critically ill patients in critical care units (CCUs) are at high risk for infections associated with increased morbidity, mortality, and health care costs. The overall infection rate in critically ill patients approaches 40% and may be as high as 50% or 60% in patients who remain in the CCU for more than 5 days. Ventilator-associated pneumonia (VAP) in mechanically ventilated patients ranges from 8% to 28%. VAP refers to an infection that develops during mechanical ventilation after 48 hours of intubation. Nurses play a pivotal role in decreasing patients' risk of acquiring VAP. Keeping pace, in this instance, is really about turning focus back to the more basic aspects of critical care nursing. Evidence now demonstrates how important basic nursing care is to the prevention of VAP by using strategies for the prevention of VAP. Objective: The aim of this study was to assess nurses' compliance of evidence-based guidelines for preventing VAP in CCUs. Methods: The study was conducted at the CCUs of Alexandria Main University Hospital namely, Casualty Intensive Care Unit (unit I) and General Intensive Care Unit (unit III). The sample of this study consisted of 60 nurses working in the previously mentioned CCUs. Two tools were used for data collection VAP Preventive interventions Observation Checklist (VAPPIOC) and VAP knowledge questionnaire (VAPKQ). Results: Nurses had different levels of adherence for many nonpharmacologic strategies. All nurses responses to the questionnaire, rates and reasons for non adherence were addressed. Conclusion: The most important barriers to implementation were environment-related. Other reasons for non-adherence were patient-related barriers being significantly important for nurses. Overall, the most important barriers to adherence were unavailability of resources. Our findings suggest the need for development of guidelines to reduce variability and the need to include the nursing point of view in these guidelines.