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Background & Aim: Extravasation is one of the complications of peripheral intravenous catheters. Doing standard nursing cares leads to more effective and safer treatment and care of extravasation and the reduction in the length of hospital stay for neonates. This study aimed to audit nursing cares related to the treatment of extravasation in neonatal intensive care units.

Methods & Materials: In this descriptive study (the audit), 200 nursing cares regarding neonatal extravasation were observed and assessed. Data gathering tool was a standard check list. The data collection method was the observation and recording of nursing cares related to neonatal extravasation in neonatal intensive care unit of selected hospitals affiliated to Shahid Beheshti University of Medical Sciences in 2015. The data were analyzed using descriptive statistics on SPSS software v.21.

Results: The standard cares were performed by nurses in some cases, and in some standards, nurses showed poor performance. Among 25 common nursing cares of extravasation, 22 cares were far from standards. After third and fourth degree extravasation, none of required nursing cares were done properly.

Conclusion: Nursing cares of extravasation for neonates in NICU are far from standard cares. This could be attributed to the lack of nurses’ awareness of the importance of proper extravasation care and its consequences, failure in nurses’ education, lack of authorities’ supervision on cares, lack of facilities and equipments, and nursing shortage.

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Background & Aim: Pressure ulcers are a common complication in patients hospitalized in intensive care units. This complication continues to be a major problem in all health care systems and reflects the quality of nursing care in hospitals. The aim of this study was to evaluate the correlation between nurses’ knowledge and quality of nursing care for prevention of pressure ulcers in intensive care units.

Methods & Materials: This was a descriptive correlational study on a purposive sample of 92 nurses employed in intensive care units of four hospitals affiliated to Shahid Beheshti University of Medical Sciences in 2014. Data were collected through a questionnaire containing demographic and occupational information, the Pieper’s nursing knowledge questionnaire, and a checklist to assess the quality of nursing care for prevention of pressure ulcers. Descriptive and inferential statistics (independent t-test and Pearson’s correlation) were used to analyze data on SPSS software v. 21. The level of significance was considered at P≤0.05.

Results: The study results showed that the average score of nurses’ knowledge of pressure ulcers prevention was a total of 75.7±6.9. The quality of nursing care in more than half of cases (54.3%) was relatively favorable. There was no significant correlation between nurses’ knowledge and the quality of nursing care for pressure ulcers (P=0.86, r=0.01).

Conclusion: In addition to inadequate knowledge of pressure ulcers prevention, the nurses did not fully implement what they knew in clinical practices. Therefore, a more accurate evaluation is recommended in this regard.

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Background & Aim: Mechanical ventilation is one of the most common treatments in neonatal intensive care unit and is however associated with many complications. One of the ways to reduce complications is providing nursing care according to standards. This study was conducted with the aim of determining the conformity of nursing care related to weaning neonates from mechanical ventilation to the standards in neonatal intensive care units.

Methods & Materials: In this descriptive study (the audit), 105 nursing cares related to weaning neonates from mechanical ventilation in neonatal intensive care units at the selected hospitals affiliated to Shahid Beheshti University of Medical Sciences were selected and observed by the event sampling method in 2015. Data were gathered through a demographic questionnaire for nurses and hospitalized newborns, a checklist of nursing care related to weaning from mechanical ventilation. The data were analyzed using descriptive statistics and Chi-square test at the significance level less than 0.05.

Results: Conformity rate of nursing care related to weaning neonates from mechanical ventilation to standards, was 68.3 percent, and compliance with the standards of care was 71.4 percent before weaning, 65.7 percent during weaning and 66.4 percent after weaning.

Conclusion: Nursing cares related to weaning neonates from mechanical ventilation are far from standards, and for its improvement, applying clinical guideline for neonatal nursing care and clinical supervision by managers for optimizing its implementation are suggested.

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Background & Aim: Nowadays in the NICU, family-centered care is the foundation of care, and communication is at the core of family-centered care. This study aimed to compare the perceptions of nurse-mother communication between neonatal intensive care nurses and mothers of hospitalized neonates.

Methods & Materials: This is a cross-sectional study. 70 mothers of hospitalized newborns and 70 nurses working in the NICU ward of university hospitals and social security hospitals in Yazd, were selected by convenience sampling in 2015. The study questionnaires included the mothers’ and nurses’ demographic characteristics questionnaire, “nurses’ perceptions of nurse-mother communication” questionnaire and “mothers’ perceptions of nurse-mother communication” questionnaire. The data were analyzed using descriptive statistical tests and independent t-test on SPSS software version 19.

Results: The mean age for nurses was 33.36±6.99 years and for mothers was 29.77±6.40 years. Mean score and standard deviation of perception of “nurse-mother communication” for nurses was 69±6.92 and for mothers was 57.66±11.99. Independent t-test showed statistically significant differences between mean scores (P<0.001).

Conclusion: Due to difference in nurses’ and mothers’ perceptions of nurse-mother communication, it seems necessary that interventions be designed and implemented to familiarize nurses with mothers’ expectations of quality and way of nurse-mother communication.

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Background & Aim: The role of caffeine as a cerebral stimulant for improving respiratory indicators in the mechanically ventilated patients is unclear. The purpose of this study was to evaluate the effect of coffee consumption on respiratory indicators among the mechanically ventilated patients in the Intensive Care Unit (ICU).
Methods & Materials: A double blind, randomized clinical trial (IRCT2013122915972N1) was performed on 80 patients who were selected by convenience sampling and randomly allocated into two groups (intervention and control). For the intervention group was administered 3.5 grams of espresso coffee powder dissolved in 80 cc water, then 20 cc water through gavage about an hour after breakfast. The control group received 100 cc distilled water. Respiratory parameters were recorded and compared in the two groups 2 minutes before the intervention and 30 minutes and 60 minutes after the intervention. Chi-square test, t-test and the repeated measures analysis of variance were used to analyze the data.
Results: There was no difference between the two groups in the baseline variables. After the intervention, the spontaneous respiratory rate, tidal volume, the minute ventilation rate and arterial O2 saturation increased in the intervention group compared to the control group, but the increase was statistically significant only for the spontaneous respiratory rate and tidal volume.
Conclusion: Espresso coffee consumption through gastric tube in the mechanically ventilated patients increases the spontaneous respiratory rate and tidal volume but does not significantly affect other respiratory indicators.
 

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Background & Aim: Infant hospitalization in the intensive care unit is stressful for parents so that it affects their parental role. Nurses, due to their special situation, can play an important role in reducing parental stress. This study aimed to determine the effect of parental role training by a nurse on stress in the parents of hospitalized newborns in a neonatal intensive care unit.
Methods & Materials: A quasi-experimental study (IRCT201605131788N17) was conducted on 72 parents (36 couples in the intervention group, 36 couples in the control group) of hospitalized newborns in the neonatal intensive care unit of Ali-Asghar hospital in 2016. The intervention group received the parental role training based on their needs. Their stress level was compared with the control group using the Parental Stress Scale. Data were analyzed by descriptive statistics, chi-square test, paired t-test, independent t-test and Fisher's exact test using the SPSS software v.16.
Results: Before the education, there was no significant difference in the stress level between the two groups (P>0.05). After the education program, the stress level in the intervention group fell on the tenth day compared to the control group (P<0.001).
Conclusion: Training parents based on their educational needs reduces their stress. By reducing stress and improving the role of parents, it can be assured that the newborn is provided with the quality care at the time of admission.
 

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Background & Aim: Exposure to high stress in the work environment among the intensive care unit nurses results in leaving the profession and their unwillingness to continue their activities. This is one of the major challenges in the nursing profession and has a great effect on the effectiveness of health systems. Despite the importance of resilience, there is few studies on the intensive care unit nurses’ resilience. The aim of this study was to determine resilience and its association with the intensive care unit nurses’ intention to leave their profession.
Methods & Materials: This is a cross-sectional, descriptive analytical study on 400 nurses working in the intensive care units of teaching hospitals affiliated to Tabriz University of Medical Sciences in 2016. Data were collected through a modified form of Anticipated Turnover Scale designed by liou and a summarized form of Connor-Davidson’s resilience scale". Descriptive and inferential statistics (Mann-Whitney, and Kruskal-Wallis) were used for data analysis through SPSS version 13.
Results: The mean rank for intention to leave and resilience was 2.83 (IQR: 0.67) and 25.50 (IQR: 8) respectively. Also, there was a negative, significant correlation between resilience and intention to leave (P<0.001, R=-0.173).
Conclusion: Considering the rate of intention to leave the profession, more attention is needed to the factors affecting the intention to leave. In addition, due to the significant relationship between resilience and intention to leave, incorporating resilience-promoting strategies into nursing curriculum is recommended.
 

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Background & Aim: Anxiety is one of the most common psychiatric disorders in the family of patients with traumatic brain injury. This study aimed to determine the effect of providing information about the patient’s condition on the anxiety level of the family members of hospitalized patients with traumatic brain injury.
Methods & Materials: This quasi-experimental study was conducted on 90 family members of traumatic brain injury patients admitted to Shahid Bahonar hospital in Kerman in 2016. The participants were selected by the consecutive sampling method and were assigned to intervention and control groups. In the intervention, the participants were informed by the nurse about changes in the patient’s condition during the first three days of admission to intensive care unit. During this period, the control received routine care. Data collection tool was the Spielberger anxiety inventory. Independent and paired t-test were used to compare the mean scores of anxiety using the SPSS software version 16.
Results: There was no statistically significant difference in the mean scores of overt, covert and general anxiety between the two groups before the intervention (P>0.05). However, after the intervention in the experimental group, the mean scores of overt anxiety (45.51±7.26), covert anxiety (45.42±6.51) and general anxiety (90.93±12.72) decreased (P<0.05) compared to the mean scores of overt anxiety (49.22±9.42), covert anxiety (49.02±9.15) and general anxiety (98.24±17.67) in the control group.
Conclusion: Providing planned information on changes in the condition of hospitalized patients with traumatic brain injury can reduce the anxiety of family members of these patients.
Clinical trial registry: IRCT20180206038642N2
 

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Background & Aim: Active participation of families can be an influencing factor on delirium in patients hospitalized in the ICU. The present study was conducted to investigate the effect of scheduled visits on delirium intensity in elderly patients hospitalized in the ICU.
Methods & Materials: This clinical trial was conducted on 70 elderly patients hospitalized in the ICU of Ali ibn Abi Talib hospital in Rafsanjan from November 1, 2017 to March 1, 2018. In the intervention group, patients were visited in two out-of-schedule sessions for three days in the morning and night. The control group received routine visits for 3-5 minutes. To assess delirium, the Neecham questionnaire with a scoring scale of 19-30 was used. The data were analyzed using the SPSS software version18.
Results: There was no statistically significant difference between the two groups in terms of age, sex and educational level. Before the intervention and one day after the intervention, no significant difference was observed in delirium score between the two groups. However, on the second day in the intervention group, the median and interquartile range for delirium were 27(3) and in the control group were 25(2) (P<0.0001). On the third day after the intervention, differences between delirium score in the intervention and control groups were 27(3) and 25(3), respectively (P<0.0001).
Conclusion: Scheduled visits can be considered an effective non-pharmacological method for preventing delirium in elderly patients hospitalized in the ICU.
Clinical trial registry: IRCT20150519022320N7
 

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Background & Aim: Decreased level of consciousness is one of the life-threatening complications associated with brain injuries. The aim of the study was to explore the effect of auditory and tactile stimulation by a family member on patients’ consciousness level.
Methods & Materials: This quasi-experimental study was conducted on 80 comatose patients with traumatic brain injury hospitalized in the intensive care units of Zahedan educational hospitals in 2019. Samples were selected by the convenience sampling methods and then randomly divided into experimental or control groups. Data collection tool included a demographic information questionnaire, and FOUR criteria for the level of awareness. For the experimental group, the intervention including auditory and tactile stimulation was performed by a family member for 10 minutes for seven consecutive days. The control group received routine interventions. To analyze the data, descriptive and inferential statistical tests (independent t-test, paired t-test, analysis of covariance, chi-square and repeated measures ANOVA) were used through the SPSS software version 21.
Results: The results indicated no significant differences in the level of consciousness between the two groups on the first and fourth days. Yet, independent t-test, analysis of covariance and repeated measures ANOVA showed that the intervention group had significantly a higher level of consciousness on the fifth, sixth and seventh days compared to the control group (P<0.001).
Conclusion: Findings showed that auditory and tactile stimulation by a family member is effective in increasing the level of consciousness in comatose patients with brain injury. So, this technique is recommended as an intervention in nursing care to increase the consciousness level in these patients.
 

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Background & Aim: Clinical decision-making is an essential part of the nursing profession. The nursing profession is based on ethical principles. Due to their commitment to patients, morally courageous nurses ignore occupational risks threatening their own lives.  The aim of this study was to investigate the relationship between moral courage of nurses and their participation in clinical decision-making.
Methods & Materials: This descriptive, cross-sectional study was conducted in 2019. The study population was nurses working in the CCU and ICU of Shahid Rajaie Cardiovascular Medical and Research Center. The sample size was 195 people. The data was collected using the Sekerka’s Moral Courage Scale, and the Participation in Decision Activities Questionnaire (PDAQ). Data was analyzed using descriptive statistics, independent t-test and Pearson correlation coefficient through the SPSS software version 19.
Results: The mean scores of moral courage and PDAQ in nurses were 90.38 ± 11.48 and 117.24±39.42, respectively. A positive correlation was found between moral courage and participation in clinical decision-makings (r=0.397, P<0.001).
Conclusion: The results showed that moral courage has pride of place in the nursing profession that can encourage nurses to actively participate in clinical decision making. Therefore, professional ethics courses are suggested to be organized to improve decision-making and clinical ethical performance of nursing students and nurses.
 

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Background & Aim: Patient safety in general and medication errors in particular are the important indicators of hospital care quality. Risk management is an important and fundamental approach to preventing events caused by medication errors. The aim of this study was to determine the effect of risk management program on the rate of medication errors among intensive care unit nurses.
Methods & Materials: The present study was a non-randomized pre-test, post-test study with a control group, conducted in 2020 in two hospitals in Tehran. The hospitals were randomly assigned to either an experimental group or a control group. According to the inclusion and exclusion criteria, 150 nurses (75 nurses in each group) were selected by the convenience sampling method. For the experimental group, a risk management program was implemented. Data collection tools included the nurses’ demographic questionnaire, the 14-item Wakefield medication error self-reporting questionnaire, and the nurses’ medication quality checklist. Data was collected before and after the intervention and analyzed by the SPSS software version 16 using descriptive and inferential statistics.
Results: The results of independent t-test showed no statistically significant difference between two groups in demographic information and the rate of medication errors before the study (P>0.05). After the intervention, difference in the rate of medication errors was statistically significant between the two groups (P<0.005), indicating a decrease in medication errors in the nurses of the experimental group compared to the control group. The results also showed that the rate of medication error observed in nurses was significantly higher than the error reported by them (P<0.001).
Conclusion: The results showed that the implementation of risk management program was effective in reducing nurses’ medication errors. Implementing a risk management program is recommended to nurses as a way to promote safe medication and achieve safe and desirable nursing care.
 

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Background & Aim: Physiological and psychological needs of intensive care unit (ICU) patients are not met due to lack of effective communication. To facilitate communication, nurses can use augmentative and alternative communication strategies (AACs). The aim of this study was to determine the effect of using these strategies on the quality of nurses’ communication with patients with endotracheal intubation in the cardiac surgery intensive care units.
Methods & Materials: In this quasi-experimental intervention study with before-after design, 70 patients (35 at each stage) who were unable to communicate verbally after heart surgery due to intubation were recruited by the convenience sampling method, and also 10 nurses in the cardiac surgery ICU were randomly selected. In the pre-intervention stage, nurses communicated with patients using conventional methods, and after training in the post-intervention stage, using AACs. Data were analyzed using descriptive and inferential statistics through the SPSS software version 22.
Results: The lowest content of communication in the pre- and post-intervention stages was related to emotions, the frequency of which was higher in the post-intervention stage compared to the pre-intervention stage. The most commonly used methods in the post-intervention phase were the communication board and head gesture. In both stages, communication was mostly initiated by the patient. In the post-intervention stage, the number of times the nurse started the communication increased (P<0.05). In the post-intervention phase, patients’ and nurses’ satisfaction with communication increased (P=0.0001).
Conclusion: Training nurses about AACs and using them for the ICU patients increase the success of communication and patients’ and nurses’ satisfaction with communication. Therefore, the use of these strategies in these wards is recommended to nurses and nursing managers.

 

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Background & Aim: Mothers with premature babies are more likely to experience anxiety than mothers with full-term babies. The separation of the mother from the baby disrupts physical contact with the baby, which is the most important component affecting attachment. The aim of this study was to determine the effect of a group positive thinking program on anxiety and attachment in mothers with premature infants admitted to the neonatal intensive care unit.
Methods & Materials: This study is a randomized clinical trial conducted in Kermanshah in 2020. A total of 72 mothers with premature infants admitted to the neonatal intensive care unit of Imam Reza and Mohammad Kermanshahi hospitals were randomly assigned into two groups of control and intervention. The Spielberger State Trait Anxiety Inventory and Postpartum Attachment Scale were used to collect the data. The collected data were analyzed using the SPSS software version 16 using statistical tests (ANOVA and Chi-Square).
Results: There was no significant difference in the state anxiety levels before (p =0.791) and after the intervention (p =0.373) between the control and intervention groups. Likewise, no statistically significant difference was observed in the latent anxiety levels before (p =0.831) and after the intervention (p =0.093) between the two groups but comparing the amount of changes showed a significant difference (p =0.025). Regarding attachment, none of the attachment subscales had a statistically significant difference between the two groups before the intervention (p>0.05). After the intervention, a significant difference was observed in the scores of the subscales “lack of hostility" and "satisfaction with the interaction" (p<0.05).
Conclusion: According to the findings of the study, the group positive thinking training is recommended to the nurses and managers of neonatal intensive care units as a complementary program, along with the routine care for mothers of premature infants.
Clinical trial registry: IRCT20210108049965N1

 

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Background & Aim: Attempting to improve the quality is an important issue in the nursing service and care system. The COVID-19 pandemic has created great challenges for healthcare systems, especially for the intensive care units, which can affect the quality of nursing care provided to these patients. The aim of this study was to determine the quality of nursing care in nurses working in the intensive care unit of COVID-19.
Methods & Materials: In this descriptive-cross-sectional conducted in 2021-22, 142 nurses from Valiasr, Amir Kabir, Amir al-Momenin and Khansari hospitals affiliated to Arak University of Medical Sciences were selected by the census method. The Martins’ nursing care quality questionnaire (including 25 items in 7 domains) was completed by the participants. The SPSS software version 16 and independent t-tests, analysis of variance and the Pearson's correlation coefficient were used for the data analysis.
Results: The result showed that the mean score of the nursing care quality was 83.83±7.74, which was considered favorable due to being higher than the median score of the tool (62.5). Among the individual characteristics of nurses, the nursing care quality had a statistically significant relationship with the type of employment (P=0.003), age, work experience and work experience in the intensive care unit (P<0.001).
Conclusion: Considering the significant relationship of the nursing care quality with the type of employment, age and work experience, it is recommended that health managers take an effective step in formulating the necessary policies to improve the quality of nursing care by taking into account the experience of skilled nurses in intensive care units.

 

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Background & Aim: Family caregivers of COVID-19 patients in the Intensive Care Units (ICUs) face numerous challenges that can affect their well-being. Spiritual health represents a crucial component for coping with such stressful conditions. Therefore, this study aims to determine the relationship between spiritual health and attitude towards death in family caregivers of COVID-19 patients post-discharge from the ICUs.
Methods & Materials: This descriptive-correlational study conducted between April and November 2021, focused on family caregivers of COVID-19 patients discharged from the ICUs. The sample comprised 260 family caregivers selected through convenience and purposive sampling methods. Data collection tools included a demographic and clinical questionnaire, Polotzin and Ellison's Spiritual Health Questionnaire, and Wong's Death Attitude Questionnaire. Data were analyzed using SPSS version 24 encompassed chi-square tests, one-way analysis of variance and Spearman correlation coefficient.
Results: The results showed a significant inverse relationship between total spiritual health score and the total score of attitude towards death (rs=-0.101, P<0.05). The attitude towards death findings revealed fear as the highest scoring dimension, with active acceptance scoring the lowest. Moreover, religious health exhibited a significant inverse relationship with avoidance of death (rs=-0.93) and fear of death (rs=-0.64, P<0.05).
Conclusion: The study highlighted an inverse relationship between the level of religious health and negative dimensions of attitude towards death. Individuals with higher religious health scores exhibited lower average scores for negative attitudes towards death, including fear and avoidance of death. This underscores the importance of emphasizing the religious dimension within families, and among patients discharged from the ICU, showcasing the role of religion in mitigating negative attitudes towards death.

 

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Background & Aim: With advancements in treatment and an increase in the prevalence of diseases, the number of patients requiring mechanical ventilation in intensive care units (ICUs) continues to rise each year. The ABCDE bundle is a multi-component, evidence-based approach designed to improve patient outcomes in the ICU. This study aimed to determine the effect of the ABCDE bundle on the risk of pressure ulcers, deep vein thrombosis and delirium in patients undergoing mechanical ventilation.
Methods & Materials: This randomized, single-blind clinical trial was conducted between September 2021 and January 2022. The sample included 100 patients undergoing mechanical ventilation in the ICU department of Imam Reza Hospital in Mashhad, who were randomly assigned to either the intervention or control group using block randomization. The intervention group received the ABCDE bundle over a period of 7 days. The control group received routine care. The criteria for assessing complications included the risk of pressure ulcers and deep vein thrombosis (DVT), evaluated at the end of the intervention and on days 0, 1, 3, 5, and 7. The study utilized several assessment tools: the COMHON Index for pressure ulcers, the Wells Deep Vein Thrombosis Scale, and the Delirium Evaluation Tool in the Intensive Care Unit (CAM-ICU). Data analysis was performed using SPSS software version 20, employing chi-square, Mann-Whitney, and independent t-tests.
Results: A decrease in the average pressure ulcer risk score was observed in the intervention group on day seven (P<0.05). In this group, the incidence of delirium fell decreased from 64.4% to 13.3% (P<0.05), indicating a statistically significant reduction. Additionally, the risk score for deep vein thrombosis in the control group significantly increased on day seven compared to the intervention group (P<0.05).
Conclusion: The use of the ABCDE bundle significantly reduces the risk of pressure ulcers, deep vein thrombosis, and delirium in patients undergoing mechanical ventilation and represents an effective strategy that can be implemented by nurses and other trained healthcare professionals.
Clinical trial registry: IRCT20190625044000N1

 

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Background & Aim: Nurses today experience high levels of fatigue that significantly impair their performance in delivering care, thereby affecting patient safety. This research aimed to determine the relationship between nurses’ compassion fatigue and alarm fatigue with patient safety in intensive care units (ICUs).
Methods & Materials: This cross-sectional, descriptive-analytical study was conducted in 2023 among 248 nurses working in the ICUs of hospitals in Golestan. A stratified sampling method with proportional allocation was employed. Data collection involved a demographic information checklist and three questionnaires assessing patient safety, alarm fatigue, and compassion fatigue. Data were analyzed using SPSS version 22, with a significance level set at P<0.05. Both univariate and multiple linear regression analyses were applied.
Results: The mean scores were as follows: compassion fatigue (86.13±25.20), alarm fatigue (22.67±7.38), and patient safety (62.23±13.67). A significant correlation was found between alarm fatigue and compassion fatigue (P<0.001). However, no significant relationship was observed between compassion fatigue (r=0.101, P=0.112) or alarm fatigue (r=0.090, P=0.158) with patient safety. Multiple linear regression analysis revealed significant associations between patient safety and work experience (P=0.031), income level (P=0.012), and employment type (P=0.039).
Conclusion: Despite moderate levels of compassion and alarm fatigue, patient safety remained within acceptable ranges, indicating that nurses continued to provide safe care even amidst occupational fatigue risks.

 

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Background & Aim: Nurses’ attitudes towards death affect their caregiving practices. Spiritual intelligence, by promoting a deeper understanding of the meaning of life and death, may improve the nurses’ attitudes towards death. This study aimed to investigate the predictive role of spiritual intelligence on attitudes towards death and care for dying patients among intensive care unit (ICU) nurses.
Methods & Materials: This descriptive-analytical study was conducted in 2023 at Shiraz University of Medical Sciences, involving a sample of 200 ICU nurses. Data were collected using instruments, including demographic questionnaires, the Death Attitude Profile-Revised (DAPR), King’s Spiritual Intelligence Scale, and the End-of-Life Care Assessment Scale (EOLCAS). Data were analyzed using SPSS software version 16.
Results: Correlation analysis showed a statistically significant positive relationship between spiritual intelligence and both caring for dying patients (P<0.01, r=0.265) and attitudes towards death (P<0.001, r=0.360). Among the dimensions of spiritual intelligence, critical existential thinking emerged as a significant predictor of attitudes towards death (P<0.001, β=1.207) and evaluation of dying patient care (P<0.001, β=0.880).
Conclusion: The findings suggest that spiritual intelligence may play a vital role in shaping positive attitudes towards death and improving the quality of care for dying patients. It is recommended that nursing managers incorporate strategies to enhance spirituality in clinical practice to optimize end-of-life care.

 

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Background & Aim: Clinical competence is crucial for enhancing the quality of patient care and increasing patient satisfaction with nurses. Critical thinking is a key factor that influences the clinical competence of nurses. Therefore, this study aimed to explore the relationship between critical thinking and clinical competence among nurses working in intensive care units.
Methods & Materials: This descriptive-correlational study involved 240 nurses working in intensive care units at hospitals affiliated with Shiraz University of Medical Sciences in 2021. Participants were selected using stratified random sampling. Data collection included demographic questionnaires, the California Critical Thinking Form B, and assessments of nurses' clinical competence. Data analysis was conducted using descriptive statistics and the Spearman correlation coefficient in SPSS software version 23.
Results: The mean total score of nurses' clinical competence was 143.53 with a standard deviation of 26.62, indicating an average level of clinical competence based on the instrument's scoring. The total score for nurses' critical thinking was 17.51 with a standard deviation of 13.41, showing a relatively high level of critical thinking among the nurses in the study. A positive and significant correlation was found between the total score of clinical competence and critical thinking (r=0.147, P=0.023).
Conclusion: The results suggest that nurses with stronger critical thinking skills also demonstrate higher levels of clinical competence. Therefore, incorporating strategies to enhance critical thinking in nursing education programs can enhance students' clinical competence, better preparing them for effective clinical judgment and decision-making in complex care scenarios.