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

Background: The medical errors that caused death within 48 hours of the error involved insulin therapy. commonly to maintain the safety of critically ill patient, nurses are trained to care and be equipped with knowledge, skills and attitude to be the instrument of care. Aim: The purpose of this study was to assess nurses, knowledge, skill and attitudes toward insulin error for diabetic critical ill patient. Setting: This study was conducted in three of the ICUs of Assiut University Hospital. Sample: Eighty critical care nurses, working in the above mentioned settings, who apply insulin therapy administration, were recruited sequentially in this study. Eighty patients who were needed to insulin therapy and assigned to the observed nurses were included in this study. Tools: Three tools were used to collect the required data; nurses’ insulin therapy performance checklist, nurses 'structured questionnaire sheet for assessment of nurse's knowledge and nurses, attitude related to insulin errors. Results: Ten (12.5%) nurses’ have satisfactory performance and 70 (87.5%) of them have unsatisfactory. Concerning their knowledge, it is found that 20 (25%) of nurses had satisfactory knowledge, while 60 (75%) of them had unsatisfactory knowledge. most of studied nurses 25 (31.25%) had making ـ247 procedural errors, while 10(12.5%) demonstrated wrong route and charting errors. Positive attitudes also found toward the nurse workload become excessive, her performance is impaired (68.75%)and fatigue impairs performance during emergency situations (82.5%) . Negative attitudes were found toward documentation insulin therapy errors decrease punishment (42.45%). negative attitudes were reflected in disbelief that insulin assignment systems reduce insulin errors (43.75%). are in need for improvement. Conclusion: It was observed that the relationship between nurses' performance and their years of experience about insulin therapy there is statistically significant relationship between nurse's performance and their years of experience (F=4.045, P=0.024). Keywords: Nurse; knowledge; skill; attitudes; insulin errors; diabetic ill patients; critical care unit

Background: Patient safety is a major component of healthcare quality, which is defined as the avoidance of causing harm to patients in providing healthcare services. The cardiac catheterization is a procedure that allows a cardiologist to get firsthand information about the patterns of blood pressure and blood flow inside the heart. Aim of the study to assess nurses knowledge and attitude for patient safety in cardiac catheterization unit. A Descriptive research design was adopted to conduct this study. The study was conducted in cardiac catheterization unit at Heart Hospital, Assuit University. Subjects The study included 40 nurses working in mentioned setting. Tools: A structured interview sheet was conducted, structured into three parts included personal data, nurses' knowledge and nurses' attitude for patient safety. Results: It was found that all of nurses (100%) had poor knowledge for patient safety. While (77.5%) of nurses had negative attitude and (22.5%) of them had positive attitude toward patient safety in cardiac catheterization unit. Conclusion: it was concluded that nurses in cardiac catheterization unit had poor knowledge and negative attitude for patient safety. Recommendations: Educational program should be done for nurses in cardiac catheterization about patient safety to improve their knowledge and attitude for patient safety. Keywords: Cardiac Catheterization, Nurses' Knowledge & Nurses' Attitude.

Chest drains are commonly used for patients who have undergone thoracic surgery the purpose of chest drains is to maintain cardiorespiratory function and hemodynamic stability by draining the pleural and mediastinal spaces of air, blood or other fluid. The most common complication are postoperative pulmonary complications which include massive lobar collapse due to mucus plugging of a central airway, Atelectasis, and a combination of one or more of these. Pulmonary care is an important part of the postoperative critical care nursing after thoracic surgery. To help in preventing pulmonary complications the patient is encouraged to using of incentive spirometer, breathing and coughing effectively support of incisional wound to maintain normal amount of oxygen in the blood, prevent the smallest part of the lung from collapsing and for effective removal of mucus from the lung. Early mobilization is effective in improving postoperative pulmonary outcomes. Therefore, the aim is to identify the Impact of implementing of standardized nursing care toward patient with a chest tube to reduce pulmonary complications after Thoracotomy. Controlled case study research design was used to conduct this research. This study was carried out at postoperative ICU in Assiut University Hospitals. The sample of this study was consisted of 60 patients, admitted to ICU after thoracotomy surgery. Tool used in this study consisted of an assessment sheet developed by the researcher for identifying impact of implementing of standard nursing care on prevention of postoperative pulmonary complication. This tool comprised four main parts: Part I:- socio-demographic and clinical data Part II: - Assessment hemodynamic state. Part III: - assessment of respiratory system and pain scale. Part IV:- assessment of infection and laboratory tests findings. The main results: Findings of the present study revealed that Significance decrease in sputum production (p<0.001) on study group versus control group. Shows highly significant decrease in pain score of study group on the 2^nd &3^rd day (p=0.005). Highly significant increase of pao2, sao2 on 2^ndday and3^rd day of study group (p<0.001). As regard to white blood count, the mean values of WBC concentration in the study group showed highly significant decrease (p<0.001) in 3^rd day of study group. Regarding to length of ICU stay were (3.27±1.202&5.23±1.75) days with highly significant decreased in study group versus control group (p<0.001).As regard to temperature showed that highly significant decrease in study group versus study group (p<0.001) (37.69±0.49 &38. 59±0.42). Conclusion applying standard nursing care was more effective to reduce postoperative pulmonary complication after thoracotomy in study group versus control group who received routine hospital care.

Nutritional support is an important aspect of the care of traumatized patients and it can result in improving wound healing, decreasing catabolic response to injury, enhancing immune system function, improving gastrointestinal structure and function, and improving clinical outcomes. However, many complications are associated with enteral feeding including gastric colonization. Routine enteral feeding schedule is not allowing time to acidify stomach with gastric pH. This may predispose the traumatized patients to acquire gastric colonization which may predispose to aspiration pneumonia. Aim: this study was carried out to investigate the effect of two schedules of intermittent enteral feeding on the development of gastric colonization Design: a quasi-experimental design. Setting: trauma ICU at Assiut University Hospitals, Egypt. Patients: A convenience sample of 80 adults' traumatized patients on enteral feeding constituted the study sample. The patients were assigned into two equal groups (group 1 and group 2, 40 patients each). Methods: The only manipulation was in the rest period and time interval in which the group 1 patients were rested 8hours at night as compared to 6hours for the group 2 ones, as well group 1 patients were having 4hours time interval between each two consecutive feeding as compared to 2hours for group 2 patients. Results: ninety percent of group 2 patients developed gastric colonization as compared to 40% of the group 1 patients with a highly significant statistical difference between both groups in this regard (p= 0.000).Conclusion: intermittent 4-hour interval enteral feeding schedule inhibit the development of gastric colonization. Keywords: intermittent enteral feeding, gastric colonization.

Background: The nurse is involved with the care of the trauma patient from arrival in the emergency department to follow-up in the trauma clinic. Chest injuries can be penetrating or the blunt type, depending on the nature and severity of the causative impact. The aim of this study was to assess nurses' performance regarding care of Chest Trauma patients at Trauma Emergency Unit. Design: Descriptive research designs were utilized in this study. Setting: This study was carried out in the emergency trauma unit at an assuit university hospital. A sample: of this study were all available nurses working in the emergency trauma unit at assuit university hospital (40). (Tools) two main tools used in this study Tool I: - ((Nurses Knowledge Questioner)) . Tool II: ((Nurses Practice observation checklist ) Results: the result revealed Level of nurses Knowledge regards total score that the majority of the nurses (70%) had an unsatisfactory Level total scores about chest trauma. The present study also revealed Nurses practice about chest trauma; that the majority of the nurses (95%) had an unsatisfactory. Level total scores about chest trauma. There was no a ststistical significant difference between nurses’ Knowledge and practice. The Conclusion the majority of the nurses was having an unsatisfactory level regarding nurses' knowledge and practice. There was no a ststistical significant difference between nurses’ Knowledge and practice. Recommendations: Regular continuous educational program plan about chest trauma Encouraging nurses to attend national and international congresses, seminars, symposia, and workshops regularly about chest trauma. Keywords: performance, Chest Trauma, for & Trauma Emergency Unit.

Nutrition support can result in improved wound healing, a decreased catabolic response to injury, enhanced immune system function, improved gastrointestinal structure and function, and improved clinical outcomes) . The appropriately and timely nutritional intervention can improve patient recovery and survival, decrease complication rates, and decrease costs. Gastrointestinal complications (vomiting, diarrhea, constipation, and abdominal distension) are most commonly associated with complications derived from enteral feeding. Aim: this study was carried out to investigate the effect of the intermittent enteral feeding schedule on the occurrence of gastrointestinal complications and the length of the hospital stay among critically ill patients at Assiut University Hospitals. Design: a quasi-experimental design. Setting: trauma ICU at Assiut University Hospitals and the study took approximately one year started from July 2010 till July 2011. Patients: A convenience sample of 80 adults' critically ill patients on enteral feeding constituted the study sample. The patients were assigned randomly into two equal groups (control group and study group, 40 patients each).. Methods: The only manipulation was in the rest period and time interval in which the study group subjects were rested 8hours at night as compared to 6hours for the control ones, as well study group subjects were having 4hours time interval between each two consecutive feeding as compared to 2hours for control group subjects. Results: There was a significant statistical difference between both groups (p=0.000)indicating lesser hospital stay among study group subjects (52.5 % of the study group subjects were hospitalized less than one month as compared to 35 % of the control group subjects were stayed between 30 to less than 45 days). It was also found that, 57.5% of control group patients developed gastrointestinal complications as compared to 45% of the study group patients (n.s). Conclusion: intermittent 4- hour enteral feeding schedule had lowered the incidence of gastrointestinal complication and length of the hospital stay. Key words: Enteral Feeding , Gastrointestinal Complications ,Critically Ill Patients.

Background Literature review cited that, Acute respiratory distress syndrome (ARDS) is one of the major manifestations of multiple organ failure syndromes, and is a leading cause of death in the Intensive Care Unit. Aimed this study to evaluate the effect of that an educational program on nurse’s performance about acute respiratory distress syndrome. Design a quasi-experimental (pre/post-test design). Setting critical care units at AlThawra Modern General Hospital Authority in Sana’a-Yemen. Method Sample was (57) critical care nurses that of all nurses working in a selected setting. The tool I: Pre /Post Nurses Questionnaire, tool II: Pre /Post Observation Checklist. Results: As regard age, of nurses were > 25 years (53%), the education level, the nursing diploma was the most (72%), experience year of nurses had an experience of less than 5 years was (65.3%). The implementation of the education program revealed the improvement of critical care nurse's knowledge, practice scores, and levels regarding acute respiratory distress syndrome with high statistical significance difference between pre and postimplementation programs, (p<0.001). Conclusion, it can conclude that implementing an educational program about acute respiratory distress syndrome care is highly effective in inducing improvement in nurses' related knowledge and practice