Background: The hospitalization of patients treated in the intensive care unit (ICU) in 5-15% of cases is associated with the occurrence of a complication in the form of ventilator-associated pneumonia (VAP). Purpose: Retrospective assessment of risk factors of VAP in patients treated at ICUs in the University Hospital in Krakow. Methods: The research involved the medical documentation of 1872 patients treated at the ICU of the University Hospital in Krakow between 2014 and 2017. The patients were mechanically ventilated for at least 48 h. The obtained data were presented by qualitative and quantitative analysis (%). The qualitative variables were compared using the Chi 2 test. Statistically significant was the p < 0.05 value. Results: VAP was demonstrated in 23% of all patients treated in ICU during the analyzed period, and this infection occurred in 13% of men and 10% of women. Pneumonia associated with ventilation was found primarily in patients staying in the ward for over 15 days and subjected to intratracheal intubation (17%). A statistically significant was found between VAP and co-morbidities, e.g., chronic obstructive pulmonary disease, diabetes, alcoholism, obesity, the occurrence of VAP and multi-organ trauma, hemorrhage/hemorrhagic shock, and fractures as the reasons for admitting ICU patients. Conclusions: Patients with comorbidities such as chronic obstructive pulmonary disease, obesity, diabetes, and alcoholism are a high-risk group for VAP. Particular attention should be paid to patients admitted to the ICU with multi-organ trauma, fractures, and hemorrhage/hemorrhagic shock as patients predisposed to VAP. There is a need for further research into risk factors for non-modifiable VAP such as comorbidities and reasons for ICU admission in order to allow closer monitoring of these patients for VAP.

In critically ill patients, normal eye protection mechanisms, such as tear production, blinking, and keeping the eye closed, are impaired. In addition, many other factors related to patients’ severe condition and treatment contribute to ocular surface disease. Reducing risk factors and proper eye care can have a significant impact on incidences of eye complications and patient quality of life after discharge from the intensive care unit (ICU). The aim of the study was to determine risk factors for ocular complication, especially those related to nursing care. The study was conducted in the ICU of a university hospital. Methods for estimating and analyzing medical records were used. The patient’s evaluation sheet covering 12 categories of risk factors for eye complications was worked out. The study group included 76 patients (34 patients with injuries and 42 without injuries). The Shapiro–Wilk test, the Spearman’s rank correlation test, the Mann–Whitney U test and the Friedman’s ANOVA test were used. The level of significance was set at α = 0.05. The most important risk factors for eye complications in the study group were: lagophthalmos (p < 0.001), sedation (p < 0.01), use of some cardiological drugs and antibiotics (p < 0.01), mechanical ventilation (p < 0.05), use of an open suctioning system (p < 0.01), presence of injuries (p < 0.01) including craniofacial trauma (p < 0.001), high level of care intensity (p < 0.01), failure to follow eye care protocol (p < 0.001), length of hospitalization at the ICU (p < 0.001), and the frequency of ophthalmological consultations (p < 0.001). There was no correlation between the incidence of these complications and the age and gender of the patients. The exposure of critically ill patients to eye complications was high. It is necessary to disseminate protocols and guidelines for eye care in ICU patients to reduce the risk factors.

Introduction: Aggression is a complex phenomenon, which can take various forms. In recent years an intensification in patients' aggressive behaviours toward medical staff has been observed. It should be the reason for further research in this field. Aim of the study: To estimate the prevalence of patients' aggressive behaviours towards nurses and paramedics. Material and methods: The study was conducted in two hospitals in the Małopolska region. The study group included 99 nurses working at the emergency department, surgical, internal, and orthopaedic wards and 13 paramedics from the emergency department. A diagnostic survey method was performed using a self-developed questionnaire. Statistical analysis was performed using χ 2 test and Spearman test. The significance level was p = 0.05. Results: The staff were quite often exposed to patients' aggressive behaviours in the workplace. The various types of physical violence were often experienced by 8.0% of respondents. More than 1/4 of the group faced different forms of verbal aggression. Medical staff working at emergency department experienced verbal aggression much more frequently than the group from other wards (p < 0.05). Although some respondents declared their participation in communication courses, no significant result of such training in decreasing exposure to patients' aggression has been shown. Conclusions: The occurrence of patient aggression towards nurses and medical rescuers, especially on emergency departments, was quite common and usually manifested in the form of verbal aggression. Preparation for dealing with aggressive patients was insufficient in the examined group.

Introduction: Burns are the fourth most common cause of injury throughout the world. Thermal burns account for 86% of these. The basis of burn disease treatment is fluid resuscitation, pain management, antithrombotic treatment, and in severe cases, surgical intervention and skin transplantation. The aim of the study was to present selected nursing diagnoses of a patient with burn disease after partial skin autotransplantation as a thermal burn treatment method while using the NANDA and ICNP® classifications. Material and methods:The study applied the case study method of a 35-year-old woman with second-/thirddegree thermal burns covering 40% of the body surface. Research techniques were used: observation, documentation analysis, and interview, using the American ABA burn depth assessment scale and the NRS pain scale research tools. Results:The main nursing diagnoses were severe pain on the injured tissue and in autografted areas, decreased myocardial oxygen demand due to the catabolic state of the body, the risk of oligovolemic shock, and the risk of graft site infection and infections on other burn wounds. The patient experienced increased anxiety and difficulties with accepting her health situation. Conclusions: The depth and extent of the trauma required skin autotransplantation in the patient. Treating the burn consisted, inter alia, of correcting fluid and electrolyte disorders, pain management, antithrombotic treatment, β-blocker administration, and transfusing blood products. Comprehensive care, requiring extended monitoring, epidemiological regime, and risk assessment of complications, was important in the nursing process. Both diagnosis classifications -NANDA and ICNP ® -proved useful in the patient's care, complementing each other.

Background: Intensive Care Unit (ICU) patients often experience pain, especially during diagnostic, nursing, and therapeutic interventions. Pain assessment using the Behavioral Pain Scale (BPS) and Critical Care Pain Observation Tool (CCPOT) are recommended, but they are difficult to do in patients undergoing deep sedation. This study analyzed the usefulness of the BPS and CCPOT scales in assessing pain among patients with varying degrees of sedation. Methods: In 81 mechanically ventilated and sedated ICU patients, 1005 measurements were performed using the BPS and CCPOT scales. The study was conducted by 3 trained observers 3 times a day (each measurement at rest, during painful nursing interventions, and after the intervention). The Richmond Agitation-Sedation Scale (RASS), the Simplified Acute Physiology Score (SAPS II), and the Acute Physiology and Chronic Health Evaluation (APACHE II) were also analyzed from medical records as well as information on the length of hospitalization and treatment. Results: It was shown that signs of pain increased significantly (p < 0.001) during interventions in patients on both scales (BPS and CCPOT), and then returned to values close to the resting period. RASS results correlated significantly (p < 0.05) and positively with the results of the BPS and CCPOT. A strong correlation was found between the results of both scales at each stage of the study (R = 0.622–0.907). Conclusions: Nursing procedures are a source of pain in analgosedated patients. The BPS and CCPOT scales are useful tools for assessing the occurrence of pain in mechanically ventilated patients, including those in deep sedation.