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Background: Nursing surveillance is the key to patient safety as nurses can prevent iatrogenic harm and protect patients in intensive care unit(ICU)from medical errors done by others. Role of critical care nurses in patient safety is influenced by the specific requirements of the specialty which need continuous, close monitoring of the patient, dynamic data analysis and anticipation of complications.Aim of the study: to assess nurses' performance regarding implementation of patient safety in the intensive care units through assessing nurses' knowledge and performance regarding implementation of patient safety in the intensive care units.Research design: A descriptive exploratory design was utilized. Methods:Subject include all available nurses working in intensive care units in Damanhur Hospital, 50 nurses from both genders, with different ages, educational levels and years of experience was selected for this study. Data were obtained through two main tools: 1) Self-administered questionnaire tool, 2) observational checklist which divided to, patient unit observational check list and performance nurses observational check list. Results: Nurses had unsatisfactory knowledge and performance. There were statistically significance correlation between nurses knowledge and performance. Knowledge and performance were found to differ significantly in relation to socio-demographic data. Conclusion:More than half of the study nurses had unsatisfactory knowledge and performance regarding implementation of patient safety measures. Recommendations:The hospital should improve ICU safety structure and design andestablishing a protocol to ensure patient safety protocol will be implemented consistently in all ICUs. The study should be replicated on large sample & in different hospitals setting in order to generalize the results.

Background: ICU scoring systems allowed an assessment of the severity of disease and death prediction. The use of prognostic scoring system to predict possibility of mortality and evaluating outcomes in critically ill patients is an important in the modern evidence -based critical care. Aim: This study aimed to assess prognostic scoring systems as a tool to predict the clinical outcomes for patient with critical condition. Design: A descriptive exploratory design was conducted to achieve the aim of this study. Setting: The study was carried out in intensive care units (ICUs) of Ain Shams University Hospital (surgical, Internal medicine and neurological ICUs) affiliated to Ain Shams University, Cairo-Egypt. Study subject: A Purposive sample of ( 200) patients admitted to the previous mentioned setting. Tools of data collection; were consisted of patient assessment tool, APACHE IV, SAPS III, SOFA and MPM II and the last tool was used (at admission MPM0, MPM at 24hrs, MPM at 48hrs and MPM at 72 hrs). Results: Revealed that, more than half of studied patients were male, with age ranged from 23.00 to 80.00 years old. The overall mortality observed was 25% in all the patients. APACHE IV predicted mortality rate sensitivity and specificity were 94.11% and 95.97% respectively. Also, APACHE IV score had moderate positive correlation between predicated ICU length of stay and real ICU length of stay. Conclusion: APACHE IV established the best discrimination and superior calibration makes it the most appropriate model for comparisons of mortality rates with the other scores in ICU. APACHE IV score was better than SAPS III, SOFA and MPM II scores as they were significantly higher between non-survivors to predict mortality and length of stay among ICUs patients. Recommendations: Applications of APACHE IV score system to assess of all admitted patient to ICU in nursing assessment.

Background: Chest tubes removal (CTR) described as one of the worst feeling for critical ill patients after thoracotomy. Unrelieved pain causes undesired consequences that had adverse effects on patient quality of care. CTR pain usually managed by analgesics, but patient showed different responses to drugs and might not provide complete relaxation.Aim: This study aims to assess the effect of cryotherapy on pain quality and intensity among patients with thoracotomy after chest tube removal. Methods: Quasi-experimental design (study & control) was utilized in this study. This study conducted in the cardio-thoracic critical care units at Cardiovascular and Thoracic Academy affiliated to Ain Sham University Hospital. A purposive sample of patients undergoing thoracotomy was included in this study. They were divided into control group and study group (70 patients in each group). Data were collected using three tools; a structured interviewing questionnaire, Standardized Linear Scale for Pain Assessment and Modified McGill Pain Questionnaire-Short Form (MPQ-SF).Results: The results reveals that 50%, 67.1% of the control and study group patients were in age group from 51-≥60 years. 62.9 and 81.4% of the control and study group were males. 42.9% of both groups were highly educated. A statistically significant differences were found between study and control group regarding pain quality immediately and after 30 minutes of cryotherapy applied after chest tube removal in terms of sensory and affective descriptors. Also, a highly significant difference was found between study and control groups regarding pain intensity immediately and 30 minutes after cryotherapy applied after chest tube removal. Conclusion: cryotherapy application was useful for improving pain quality and relieving intensity of pain among patients with thoracotomy after application of cryotherapy following chest tube removal. Recommendations: Encourage nurses in critical care settings to make decision about applying cryotherapy as a nonpharmacological modality for reliving chest tube removal pain

Background: Ischemic heart disease is the leading cause of mortality worldwide, in both high-and low-income countries, according to the latest data of the World Health Organization in a report updated in 2015, the death rate from ischemic heart disease worldwide amounted to 12.8%. Aim: This study aimed to assess factors affecting the outcomes of patients with ischemic heart disease at intensive care units. Design: A descriptive design was used. Setting: the study was carried out at the intensive care units at As-salam International Hospital, Maadi. Subjects: A convenient sample of all the available staff nurses (n =100 nurses) and a purposive sample of 400 patients with ischemic heart disease. Data collection tools: (1) Patient Interview Questionnaire, (2) Nurses' Interview Questionnaire, (3) Nurses' Practice Observational Checklist (4) Patients' Outcomes Assessment Sheet. Results & conclusion: many factors affecting patients' outcomes, patients related factors (demographic and medical data, knowledge the majority of the studied subjects had satisfactory level, more than two thirds of them had satisfactory level of self-reported practice regarding IHD and their management, psychological and beliefs related factors with the mean of 275.75+102.357 and 339.57+60.43 respectively, health care system and medical team related factors with the mean of 318.75+70.25 and 371.91+18.58 respectively, the majority of nurses had satisfactory level knowledge and practice regarding care of patient with ischemic heart disease patients related factors. Also, the study finding related patients outcomes revealed majority of patients had length of stay in intensive care units 1-5 days, modified early warning score was 18% of low score, more than the half of median score and the minority of them had high score, while majority of the studied patients suffered complications, 3.75% of them had readmission within the first 6 months after discharge and 1.25 % of them suffered mortality. Recommendation: conducting further studies for studying other factors affecting outcomes of patients with ischemic heart disease, conducting educational and in service training programs for nurses and using of the modified early warning score tool to improve nurses' performance regarding caring for critically ill patients and ischemic heart disease and quality of patients' life.