Hamed Reihani, Azadeh Haghiri,
Volume 10, Issue 2 (6-2007)
Abstract
Introduction:Decubitus ulcer is a pressure-induced tissue injury that may affect skin, muscle, connective tissue, cartilage and bone. The present study was designed to find out risk factors of decubitus ulcer in head and spinal cord injured patient admitted to intensive care units (ICU). Materials and Methods: In this cross - seetional analythical study all consecutive craniospinal trauma patients admitted to intensive care unit were included.Upon arrival at the hospital and every 48 hours, all patients were examined for existence of bed sore. Braden scale, age, kind of mattress, site of primary injury and level of consciousness were used to determine risk factors. Data was analyzed using T and Chi square tests and logistic regretion. Results: Among 198 patients (171 male, 27 female with mean age of 31.4=19.8), 166 patients (3.8%) had cranial and 32 (16.2%) patients had spinal trauma. Of samples, 45 (22.7%) patients had 67 sores in 13 different sites. Incidence of bed sore was 22.7% (in cranial and spinal injured patients was 4.54% and 18.18% respectively). The most common sites were intergluteal cleft (33.3%) and sacral regions (28.9%). Bed sores were observed more frequently in immobile patients and those with impaired sensation, the difference were statistically significant (p<0.005 and p<0.005 respectively) hence immobility and impaired sensation are known as risk factors. Patient’s sores were not influenced by age, moisture, activity, nutrition and type of mattress variables. Time of hospital stay in patients with bed sore was significantly more than those without bed sore (P<0.00001). Coma patients (GCS 8) had developed bed sore more frequently than conscious ones (OR=6.1, RR=4.4, P=0.00001). Conclusion: Results show that risk factors of deubitus ulcers in ICU admitted craniospinal trauma patients were decreased sensation, activity and level of conciousness and lenglt of hospital stay.
Mahmood Haghiri, Vahab Habibpour, Nahal Moharekpour, Morteza Ghasemi,
Volume 25, Issue 2 (June & July 2022)
Abstract
Background and Aim This study aims to investigate the effect of nurses’ autonomy on the quality of patient care based on Kramer and Schmalenberg’s model
Methods & Materials This is a causal-comparative study. Participants were 101 nurses of Imam Khomeini Hospital in Arak, Iran from the intensive care unit and internal medicine, surgery, pediatrics, gynecology, orthopedics, and emergency departments. The data collection tools were Moghimi and Ramazan’s patent care quality questionnaire and an autonomy assessment questionnaire based on Kramer and Schmalenberg’s autonomy model. The data were analyzed in SPSS software.
Ethical Considerations This study was approved by the ethics committee of Islamic Azad University of Arak Branch (Code: IR.IAU.ARAK.REC.1397.66).
Results The mean autonomy score of nurses was 3.16 ±0.35, indicating a desirable level. Nurses of all departments had limited autonomy. In the internal department, nurses had unsanctioned autonomy, while in the surgical department, they had autonomous nursing care action. The regression models were significant for all departments except for the internal department. With an increase of one unit in limited autonomy in the intensive care unit, autonomous nursing care in the surgical department, and limited autonomy in pediatrics, gynecology, orthopedics, and emergency departments among the nurses, the quality of care can be increased by 0.253, 0.187, 0.522, 0.205, 0.466 and 0.129, respectively.
Conclusion Nurses’ autonomy can increase the quality of patient care. The nursing managers need to empower nurses and provide an environment for them to apply their knowledge in practicing autonomy.
