The importance of cuff pressure in endotracheal tube management cannot be overstated. Guidelines recommend that a cuff pressure should be in a range of 20 to 30 cm H2O. Low cuff pressure increase risk for micro-aspiration of subglottic secretions. This micro-aspiration is considered the major pathogenic mechanism for ventilator-associated pneumonia, complication with marked morbidity and mortality. Aim: This study was carried out to determine the relation between endotracheal tube cuff pressure and the incidence of ventilator-associated pneumonia. Design: Descriptive research design. Setting: In two critical care units at Assiut Main University Hospital: Trauma ICU and general ICU. Subjects: A convenience sample of 60 critically ill patients. Tools: Three tools were utilized to collect data of study, Tool I: Patient assessment sheet. Tool II: Endotracheal tube cuff pressure measurements. Tool III: Ventilator- associated pneumonia assessment sheet. Method: The researcher used preparatory, implementation and evaluation phases to implement this study. Results: Finding of the present study revealed that there was significant statistical relationship between endotracheal tube cuff pressure and incidence of ventilator associated pneumonia with (P value < 0.05). Conclusion: There is a significant statistical relation between endotracheal tube cuff pressure and incidence of ventilator-associated pneumonia. Recommendations: Endotracheal tube cuff pressure measurements should be standardized as a basic part of care provided to all critically ill patients in intensive care units. Keywords: Cuff pressure, Endotracheal tube & Ventilator associated pneumonia

Immediate care is an essential nursing function to identify early deterioration in mental status. The nurse monitors the patient's mental status closely .Oxygen is administered if oxygen de-saturation occurs. The nurse monitors for fever or abdominal pain. This may be a signal the onset of bacterial peritonitis or other infection. Aim of the study was to investigate the immediate nursing care for hepatic encephalopathy patients' to reduce gastrointestinal complication on patient's outcome. Subject and methods descriptive research design was used to conduct this research. The sample of this study was consisted of 60 patients. Tools used in this study comprised three main tools. Tool 1:- patients assessment sheet. Tool 11:-fluid intake and| output and nutrition assessment. Tool 111:- Evaluation sheet. The main result:- Regarding West- haven criteria there was a significant decrease for the studied group from 1 st day and 2nd day. There were statistical significance differences between the two days. Regarding complete blood picture; WBC in the studied group showed that significant decrease on 2nd day. Fluid intake & output in the studied group showed that significant increase on 2nd day. Conclusion:- Applied immediate nursing care significant to reduce gastrointestinal complication in hepatic encephalopathy patients and improve the patient's outcome. Therefore, it is recommended to providing nutritional counseling for all patients with hepatic encephalopathy, continuing Educational Nursing Programmes to access the high quality of care. Keywords: Hepatic encephalopathy, immediate nursing care, patient's outcome

Aims and objectives: To compare the effectiveness of clinical pathway-directed care to usual care on hospitalisation-related outcomes in patients with severe traumatic brain injury (STBI). Background: Severe traumatic brain injury is a major cause of disability and mortality in young adults. Clinical pathways endeavour to bring evidence and clinical practice closer together to foster the delivery of best practice and to improve patient outcomes. Design: Quasi-experimental study. Methods: The study was conducted in a trauma intensive care unit of a large teaching hospital in Egypt. Patients aged 18–60 years with a diagnosis of STBI, a Glasgow Coma Scale score between 3–8 and a nonpenetrating head injury were consecutively assigned to 15 days of care. The outcomes assessed were complications related to hospitalisation, clinical variances, length of intensive care unit (ICU) stay, ICU readmission rate and patient/family satisfaction. Results: Sixty participants completed the study (30 in each arm). Apart from age, there were no significant differences between groups in baseline characteristics. The clinical pathway group demonstrated statistically significantly fewer cases of hospitalisation-related complications on day 15, and a significantly shorter length of ICU stay, lower ICU readmission rate and a high level of patient/family satisfaction when compared with the usual care group. The effect of the intervention on fever, pressure ulceration, hyperglycaemia and readmission to the ICU was no longer statistically significant after controlling for age. Conclusions: The findings of the current study suggest that the implementation of a clinical pathway for patients with severe TBI may be helpful in improving the patient experience as well as some hospitalisation-related outcomes.Relevance to clinical practice: The provision of clinical pathway-directed care in a trauma ICU may offer benefits to the patient, family and institution beyond that provided by usual care. KEYWORDS care pathways, clinical effectiveness, evidence-based practice, outcomes, patient satisfaction, severe traumatic brain injury

Background: Impaired cough increases risk of reintubation in patients who pass a spontaneous breathing trial and have their endotracheal tube removed .Semi-quantitative cough strength score (SCSS) used to evaluate the patients’ cough strength which was scored from 0 to 5 according to the obtained patient response Aim: to evaluate factors affecting extubation outcome by using (SCSS) Design: descriptive design. Setting: intensive care units of anesthesia department at assuit university hospital. Subjects: convenient sample of 80 patients who were ready for weaning off mechanical ventilator, aged from 18-65 years old, mechanically ventilated more than 24hours and of Glasgow coma scale (GCS) of 12-15. Tools: Tool I Assessment sheet. Tool II: SCSS Tool III: factors affecting extubation outcome assessment sheet Method: Before extubation, patients positioned at 30° to 45°, SCSS was measured by asking patient to cough using his full power, then disconnecting him from the ventilator. Results: 80% of the patients with (grade =0) reintubated in comparison with 79% of patients with (grade =5) successfully extubated. Conclusion: The most common factors affecting extubation were copious secretions, diminished consciousness, hypoxemia and anemia respectively. Keywords: Semi-Quantitative Cough Strength Score (Scss), Extubation Outcome & Mechanically Ventilated.

Background: National End of Life Care featured that most patients (>70%) of hepatic disease dying from liver disease. In this manner there is have to expand familiarity with basic of critical nurse's performance aboutend of life care of hepatic patients. Aim: Present study aimed to evaluate the effect of teaching program on critical care nurses Performance about end of life care for hepatic patients. Setting: Study was led in Intensive care units at El Raghy University Hospital. Subjects: Fourty nurses were included in the study. Tools of data collection: there are two tools used to collect data: (Tool l) Knowledge assessment questionnaire (Tool II) observational check list. All nurses divided into small group and received the teaching program. Evaluate nurses performance Pre and post test was complete immediately after program implementation. Results: There is very highly statistical difference between nurses' knowledge in Pre &Post test program (p<0.05). Most of nurses had unsatisfactory level preknowledge with percentage (77.5%); Also most of Post Study group had satisfactory level with percentage (90.0%). Conclusion: strengthening of basic care nurses knowledge and practices would have a positive impact on their knowledge and practice. Recommendation: Provide education through end of life Nursing Education Consortium modules for all critical care nurses. Keywords: Critical Care Nursing, End of life care, Hepatic Patient & Teaching Program.

Background: Aim of the study was to assess the nurses' performance regarding fluid, electrolytes and acid base imbalances for pediatrics and neonates. Research design: A descriptive research design was used. Setting this study was carried out in the paediatric and neonate intensive care at Assuit university paediatric hospital .Study sample consisted of all available nursing staff (130) nurses above mentioned setting.Tools were utilized for data collection: First tool nurses knowledge assessment tool, Second tool Nurses practice assessment tool. Results: The result of this study found that the majority of studied nurses were at the age group of 25 to < 30, females, married, and 58.5% were secondary school of nursing. Nearly half (47.7%) of studied nurses were having poor level of knowledge regarding fluid, electrolytes and acid base imbalances, and more than half(69.2%) of studied nurses have good level of performance, there were statistically significant difference between knowledge and practice of studied nurses regarding fluid, electrolytes and acid base imbalances. Conclusion: The general score of nurse poor level of knowledge and good level of practice regarding fluid, electrolytes, and acid base imbalances. Recommendations Provide in-service training programs for nurses to improve their performance regarding fluid, electrolytes and acid base imbalances. Key words: Performance, Fluid, Electrolytes, Acid Base & Imbalances.

Background: Acute pancreatitis is the inflammation of the pancreas that results in auto-digestion by its own pancreatic enzymes. The educational program is considered to be an important means to provide nurses with theoretical and technical information needed to acquire skills and competencies necessary to continually improve nursing practice. Objective: Theaim of this study was to evaluate effectof educational program on nurses 'performance regarding patients with acute pancreatitis. Design: A quasi-experimental research design was used to conduct this research. Setting: The study was conducted in intensive care unit at Assiut University Rajhy Hospital for Liver. Subjects: All available nurses about 40 nurses. Tools: Data were collected using: tool1 nurse’s knowledge assessment questionnaire, tool II nurse’s observation checklist. The Results revealed that majority of the nurses their age less than 40 years old, with mean age of 25.98±6.46, female, where about 52.5% of study nurses had married. The majority of nurses had unsatisfactory total knowledge pre education program. It improved immediately post education program. Conclusion: The study concluded that the education program lead to significant improvement in nurses' knowledge and practice about acute pancreatitis. Recommendation: Continues educational nursingprogram about care of acute pancreatitis patients. Keyword: Acute Pancreatitis, Education Program & Performance.

Introduction: Hypoxemia is a common finding among critically ill patients irrespective of their underlying diagnosis. this study Aimed to evaluate the Effect of implementing teaching program on nurses' performance regarding hypoxia for critically ill patients. Design: Quasi experimental design was used in the current study. A convenience sampling of 30 nurses participated in this study. Two tools ;I were utilized knowledge assessment' questionnaire and observational checklist. Method; The teaching program was conducted over 10 repeated lectures during different working morning shifts in an average of 6 sessions per week for one month; each lecture was taking about 1.5 hours. The instructional program included presentation and watching some educational videos for the practical skills related to care of hypoxia. Results: the results revealed that nurses had lack of knowledge and practices regarding hypoxia in the critical care department, however, the hypoxia teaching program showed a positive impact in improving nurses’ knowledge and practice regarding hypoxia. Conclusion: The designed instructional program was having an effective, sustainable impact on improving nurses’ knowledge and practice regarding hypoxia in the critical care department. Recommendations: Implementation of continuous education programs regarding hypoxia can play a part in supporting clinical practice. Keywords: Critically Ill, hypoxia, Nurses' performance & Teaching Program

Background Many patients with percutaneous balloon valvuloplasty had multiple complications. Thus, they need special nursing guidelines to reduce complications and improve outcomes needed for those patients. Aim of the study To evaluate the effectiveness of nursing guidelines on outcomes of patients with percutaneous balloon valvuloplasty. Research design A randomized control trial was utilized in this study. Settings The study was conducted in the cardiac catheterization unit at Al Orman University Hospital. Sample A convenience sample of 60 patients who were admitted to cardiac catheterization to receive percutaneous balloon valvuloplasty was divided into two equal groups; Intervention and control groups. Tool I patients' assessment sheet, it included four parts; sociodemographic data, patient's assessment measurements, laboratory investigations, and pain scale. Tool II: complications and patient outcome. Methods: the researchers assessed the hemodynamic parameters before and after the procedure. Results more than half (56.7%) of the study group had no large hematoma but most of the control group had < 5 cm of hematoma until discharge of percutaneous balloon valvuloplasty. There was a statistically significant difference between both groups regarding pain, hematoma, and bleeding. Conclusion: Nursing guidelines lead to significant improvement in the outcomes of patients with percutaneous balloon valvuloplasty. Recommendation Keep the nursing guideline of percutaneous balloon valvuloplasty available in the cardiac catheterization unit. Keywords: Nursing guidelines, Outcomes & Percutaneous balloon valvuloplasty