Effects of Different Head-of-Bed Elevations and Body Positions on Intracranial Pressure and Cerebral Perfusion Pressure in Neurosurgical Patients.

PURPOSE: The aim of this study was to evaluate the effects of different head of bed (HOB) elevations and body positions on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) and to identify safe positions for neurosurgical patients with different Glasgow Coma Scale (GCS) scores. METHODS: This study with a quasi-experimental, prospective repeated measures is designed with control over the intervention consisted of 30 patients hospitalized in the neurocritical care units (NCU). Patients' HOB was elevated (degree of 15,30,45) and the patients were at supine, left lateral and right lateral positions. ICP and CPP were recorded for each patient. RESULTS: It was found that ICP increased and CPP decreased at supine, left and right lateral positions with different HOB elevations, which, however, did not reach statistical significance. When patients with a GCS score of 3-8 were at degree of 15 right and left lateral positions and 45 right lateral position; and when patients with a GCS score of 13-15 were positioned at degree of 15 left lateral, ICP and CPP changed significantly. CONCLUSION: The results of this study showed that different positions the patients' HOB (degree of 15,30,45) led to slight insignificant changes in ICP and CPP; and these values were maintained within the ranges established by recent guidelines.

Effects of oral care with glutamine in preventing ventilator-associated pneumonia in neurosurgical intensive care unit patients.

PURPOSE: The study was designed as a randomized, controlled, experimental study aiming to determine the effects of oral care with glutamine in preventing ventilator-associated pneumonia in patients admitted to neurosurgical intensive care unit. METHODS: The universe consisted of patients who are admitted to neurosurgical intensive care unit between January 2014 and August 2015, while the sample consisted of 88 patients who fulfilled the inclusion criteria and were randomly selected. The study group received oral care with 5% glutamine, whereas the control group received oral care with 2% chlorhexidine gluconate solution. DATA COLLECTING TOOLS: All date was acquired using Patient Information Form, Acute Physiological and Chronic Health Evaluation scale (APACHE II), Beck Oral Assessment Scale (BOAS), Mucosal Plaque Score (MPS) and Clinical Pulmonary Infection Score (CPIS). One-way ANOVA test was used for comparing parameters with normal distribution between groups along with descriptive statistical methods. Kruskal-Wallis Test was used for comparing parameters without normal distribution between groups. RESULTS: In the control group, mean BOAS score was 9.33±1.8 mean MPS score was 3.68±0.87 and mean CPIS score was 4.07±1.78. In the study group, mean BOAS score was 10.16±2.78, mean MPS score was 3.93±1.04 and mean CPIS score was 3.78±2.25. There was no statistically significant difference in mean scores at 1st day, 3rd day, 5th day and discharge (p>0.05). However, BOAS, MPS, CPIS and APACHE II scores was significantly lower at discharge than 1st day in both groups. CONCLUSION: There was no significant difference in using 5% glutamine or 2% chlorhexidine gluconate solution for oral care for the prevention of ventilator-associated pneumonia. Similar studies with bigger sample size and longer term should be conducted for better results.

The effect of nursing care protocol on the prevention of central venous catheter-related infections in neurosurgery intensive care unit.

PURPOSE: This clinical study was planned to determine the effect of Nursing Care Protocol on the prevention of central venous catheter-related infections in neurosurgery intensive care unit. METHOD: The study was conducted between January 2012 and December 2013. The sampling consisted of 160 patients compatible with study inclusion criteria (80 protocol and 80 control patients). Routine care was applied to the control group while the protocol group received catheter care according to the protocol formed in accordance with the suggestions of the Centers for Disease Control and Prevention. The data were collected from Patient Information Form, Follow-Up Form, and APACHE II scores. RESULTS: A significant difference existed between the two groups in terms of mean APACHE II scores on discharge (p<0.05) whereas no significant difference in terms of mean fever, number of leucocytes and lymphocytes, C-reactive protein, and days of catheter carriage (p<0.05). Hemoculture positivity was less in protocol group, and this difference was statistically significant (p<0.05). CONCLUSION: The suggested nursing care protocol is significantly efficacious in the prevention of CVC-related infections. Training of healthcare workers on using this protocol is recommended.

The effect of nocturnal patient care interventions on patient sleep and satisfaction with nursing care in neurosurgery intensive care unit.

BACKGROUND: Sleep disturbance in an intensive care unit is a common problem. One of the main factors causing sleep disturbances in an intensive care unit is nocturnal patient care interventions. AIMS AND OBJECTIVES: This study aims to determine the impact of patient care interventions performed at night in a neurosurgical intensive care unit on patients' sleep and their nursing care satisfaction. METHODS: The descriptive study was conducted on 82 patients in a neurosurgical intensive care unit between January 2009 and March 2010. The data were collected by data collection instruments and Newcastle Satisfaction with Nursing Scales. The data were statistically analyzed by frequency, mean, standard deviation, chi-square, and Mann-Whitney U test. RESULTS: The study showed that 53.7% of the patients experienced sleep disturbances in the neurosurgical intensive care unit. Because of nursing interventions at night, 39.1% of these patients had their sleep affected, but this problem did not cause any negative impact on the patients' satisfaction (Newcastle Satisfaction with Nursing Scales score = 88.21 ± 9.83). The patients received, on average, 42.21 ± 7.45 times patient care interventions at night; however, the frequency of patient care interventions at night showed no effect on sleep disturbances in this study (p > .05). The most frequently given patient care interventions were, respectively, vital signs monitoring, neurological assessment, and repositioning in bed. These interventions were performed commonly at 6 a.m., 12 a.m., and 7 p.m. CONCLUSION: In this study, despite the patients reporting sleep disturbances in the neurosurgical intensive care unit because of nocturnal patient care interventions that prevented them from sleeping, the patients' satisfaction on the given nursing care was not negatively impacted. To reduce sleep disturbances because of nursing care initiatives and promote uninterrupted sleep in the intensive care unit, it can be useful to develop new protocols regulating night care activities.

Nursing activities in intensive care units in Turkey.

This cross-sectional study was conducted to determine applications practiced by nurses working in intensive care units of various institutions in Turkey. The research setting was neurosurgery, surgery, coronary and general intensive care units. The population of the study comprised nurses working in intensive care units, which were under the scope of this study, and these nurses' functions were studied. Data were collected using a Personal Information Form, the Cheltenham Patient Classification Scale and Nursing Activity List. It was observed that nurses spend most of their time on direct nursing care, clerical nursing duties and patient assessment. The most frequent activities included recording observations, calculating fluid balance, recording ventilator parameters, talking to patients, conversation not task orientated, drug preparation and administration. Although nurses spend most of their time on direct nursing care, they might also be obliged to get around to activities not in relation with direct patient care.

Levels of anxiety and ways of coping of family members of patients hospitalized in the Neurosurgery Intensive Care Unit.

OBJECTIVE: To evaluate the levels of anxiety and ways of coping of family members of patients hospitalized in the Neurosurgery Intensive Care Unit (NICU). METHODS: The descriptive study was carried out with the families of 120 patients hospitalized in the NICU of a University Hospital in Turkey, between November 2005 and July 2006. Data were collected using a questionnaire for demographical information, The State and Trait Anxiety Inventory, and Ways of Coping Inventory. Statistical analysis of the data was carried out with SPSS software, using arithmetic mean and standard deviation, percentage, t test, Kruskall Wallis, Mann-Whitney U, and correlation analyses. RESULTS: Of the family members evaluated, 56.7% were males and the mean age of the family members was 34.7+/-11.13. The average score for the State Anxiety was 47.03+/-9.55, and Trait Anxiety was 44.11+/-7.62. Financial problems were the main source of anxiety, being experienced by 56.7% of the participants due to hospitalization of the patient in the intensive care unit. Submissive and helpless coping styles were observed more frequently, as the level of anxiety increased. CONCLUSION: In light of these findings, it has been found that members of the families of the patients hospitalized in the NICU experienced a significant amount of anxiety, and that they faced difficulties in coping with anxiety, indicating that they require help and support.