Sleep disturbance among hospitalized patients has many factors especially at critical care units. Daily breathing exercises as pursed lip breathing (PLB) and diaphragmatic breathing improves sleep quality and reduces the occurrence of delirium. Aim of the study Evaluate the effectiveness of using breathing exercise on sleep quality among hospitalized patients. Design quasi experimental design. Sample A purposive sample including 152 patients were divided into four equal groups two from the Medical ward (study and control) 38 patients each group and two form the Medical Intensive Care Unit (MICU) (study and control) 38 each group at Minia university hospital. Results majority of the groups were male; all patients were in the middle age. (39% and 44.7%) of the medical ward groups (study and control) and (52.6% and 44.7%) respectively of the MICU groups had sever sleep problem. But after applying breathing exercise for 3 continuous days, the study groups (44.7%) of the medical ward and (50%) of the MICU had great sleep quality. Majority of study group's patients at the medical ward and MICU had no Confusion," with percentage (60.5% and 52.6%) respectively which mean no presence of delirium. Conclusion breathing exercise had significance effect on improving sleeping quality and reduce the occurrence of delirium among the study groups than the control groups.

Context: Modified ventilator bundle is the group of interventions supported by evidence to prevent ventilator-associated pneumonia and other related complications that commonly occurred in mechanically ventilated patients. Furthermore, it helps in reducing the mortality rates and hospital length of stay. Aim:  The current study aimed to apply a modified ventilator bundle and evaluate its effect on weaning and ventilation days among critically ill patients. Methods: A quasi-experimental research (study/control group) design was utilized. This study was conducted at the following critical care units (surgical, medical, and cardiac care units) affiliated to Bani Suief University Hospital in Bani Suief city, Egypt. A Purposive sample of 100 mechanically ventilated patients was divided into two groups. The study group included patients who received a modified ventilator bundle, while the control group included patients who received routine hospital nursing care. Data collection tools included two tools. The first tool is a patient assessment record, and the second tool is the weaning process assessment checklists using burns wean assessment program score. Results: 68.0% of the study group, compared with only (40.0%) of the control group, had a shorter duration of mechanical ventilation support between (4- 6) days with mean ± SD of 6.1 ± 1.6 and 7.3 ± 1.9, respectively after modified bundle implementation with statistical significance differences (p-value 0.005). The study group of patients obtained higher weaning scores than the control group according to burns weaning scores.   Conclusion: The study group demonstrated higher weaning scores and shorter ventilation support duration than the control group. Developing a simplified and comprehensive training associated with demonstrative booklet, including information about ventilator-associated pneumonia, components of modified ventilator bundle, and its importance for ventilated patients to improve nurses' knowledge and practice. Furthermore, replicating the current study on a larger probability sample from different geographical locations to generalize results.

Background: CKD patients received intradialytic rehabilitation program developed improvement in their general health. Exercise also improve solute removal which increase the HD efficiency. Aim: to evaluate the impact of intradialytic rehabilitation program on general health of CKD patients. Design: Quasi experimental. Setting: The study conducted at hemodialysis unit of Minia urology hospital. Sampling: 60 patients divided in two groups 30 for each. Results: more than half of both groups were female. More than half of both group were diabetic and hypertensive. Mean age of both groups were (39.73 ± 8.17) & (40.00 ± 8.27). The 6 MWT was lower in the control group (325.3 ±24.1, 310.6 ±18.3 & 308 ±17.8) at the three observations than the study (352.3 ±46.8, 393.8 ±78.4 & 448 ±26.9). Small percentage of the rehabilitation group experienced dyspnea (16.6 % and 26 %). The study group showed improvement in mean serum creatinine (4.85± 0.54 & 4.58±0.54) than the control group (5.58± 0.68 & 5.58± 0.68). After rehabilitation program half of the study had low depression and only (13.3%) of them had high depression level. Conclusion: Intradialytic rehabilitation program for CKD patients enhance their activities of daily living abilities which improves their psychological health status.

Background: Nurses in ICU play a significant role in providing end of life nursing care to patients complained from lifethreatening illnesses and did not response positively to medical treatment by assessing their needs and providing comprehensive nursing care Aim of the study: Evaluate Nurses knowledge, attitudes and practices about end of life care at critical units. Design: Descriptive research design. Methods: (65) ICU nurses included in the study assigned to the medical and general ICUs at

Oral hygiene is an essential aspect of daily nursing care activity, Oral hygiene in critical often neglected or performed inadequately. Literature cited many oral hygiene solution as Chlorhexidine, Sodium Bicarbonatele, hydrogen peroxide and normal saline. Oral hygiene solutions leads to decrease colonization of the oropharynx, remove debris, and lowers VAP level. Literatures did not mention the most effective method including the solutions and the appropriate frequency of oral hygiene for critical ill patients. The aim of study: is to evaluate the effect of two standardized oral Hygiene methods on bacterial colonization in mechanically ventilated patients. Patients and method: A quasi experimental research was conducted at ICU of Minia university hospital. Sixty adult critical patients assigned randomly in two groups, 30 for each. Chlorhexidine (0.2%) group (A) and Sodium Bicarbonate (0.1%) group (B). Three tools used : Bacterial Colonization Indicators, Beck Oral Assessment Scale & Mucosal-Plaque scale. Results: on 7th day of the study a higher percentage (87 %) of Chlorhexidine group (A) had good oral integrity, and only (26.7 %) of the same group had VAP than group (B) (73.3 %). Conclusions: Oral hygiene using tooth brushing with Chlorhexidine leads to improve oral cavity reducing colonization as well as VAP prevention.