younes ahmad | Damanhour University (original) (raw)

Papers by younes ahmad

Alexandria Scientific nursing journal, Mar 1, 2022

Background: Endotracheal intubation and mechanical ventilation are essential lifesaving procedure... more Background: Endotracheal intubation and mechanical ventilation are essential lifesaving procedures for many critically ill patients. Tracheal intubation with a cuffed tube is considered definitive airway management in adults. The tube cuff is designed to provide a seal against aspiration and to prevent leaks during positive pressure ventilation. A cuff pressure between 20 and 30 cmH2O has been proposed guideline published by the Royal College of Anaesthetists to prevent the complications of over/under inflation of the cuff. Objective: To compare the endotracheal tube cuff pressure measurements before and after nursing interventions among mechanically ventilated patients. Settings: The study was carried out in the general ICU at Damanhour Medical National Institute that consist of three main halls with fifteen beds; hall I (4 beds), hall II (4 beds), and hall III (8 beds).. Subjects: A convenient sample of 70 adult patients who were mechanically-ventilated via an endotracheal tube with high-volume low-pressure cuff and a diameter ranging from 7-8.5 mm were included in the study. Tools: one tool was developed by the researcher used for data collection namely "Endotracheal tube cuff pressure measurement record". It was used to record the endotracheal tube cuff pressure measurements before and after the selected nursing interventions. It consists of three parts. Cuff pressure was assessed before nursing interventions and after nursing interventions. Results: The majority of the studied sample was male with age 51-60 years. Results of the study showed that there was a significant decrease in the mean values of endotracheal cuff pressure starting before till 30 minutes after the complete bed bath, oral hygiene, and right and left lateral positioning procedures. Conversely in the endotracheal suctioning, the mean value of ETT cuff pressure before showed an increase immediately after, followed by a decrease after 15 minutes, then an increase after 30 minutes. Conclusion: The study concluded that the cuff pressure measurements were significantly changed after performing the selected nursing interventions at different timing. Recommendations: Conducting educational program for the ICU nurses to indicate the importance of the endotracheal tube cuff pressure measurement after performing each of selected nursing interventions.

Mansoura Nursing Journal, 2015

Triage is one of the most important managerial and decision making concepts in emergency, it brin... more Triage is one of the most important managerial and decision making concepts in emergency, it brings the most benefit to the greatest number of patients. Triage is important for redistributing and reducing waiting times and enhancing patient and family satisfaction and improving the quality of health care. Therefore, the aim of this study to determine the effect of implementing triage training competencies on newly graduated nurses (NGNs') working in emergency department (ED) at emergency hospital. Patients and Methods: A quasi experimental research design was utilized during the current study and it was conducted on 50 NGNs' who have a bachelor degree of nursing and are involved in providing direct care for emergency patients in the Emergency Hospital at Mansoura University and who are willing to participate in the study was constitute the study sample (study group). While control group of (25 nurses) who have a bachelor degree of nursing and are involved in providing direct care for emergency patients in Talkha Hospital. Results: The mean triage knowledge score increased immediately and post program implementation for the study group from (32.9±1.73 to 32.6±1.78 out of a total score of 35) compared with (13.44±1.78) to (13.52±2.04) for the control group. Also, triage performance increased immediately and post program implementation for the study group from (135.5±4.26 to 134.42±2.41 out of a total score of 140) compared with (56.44±8.21) to (56.76±7.79) for the control group. Moreover, there was a highly statistical significance difference between the study group and control group in relation to NGNs' knowledge and practice in post and two month post program implementation *p = 0.001. While there was no statistical significant difference between study group and control group in pre program implementation. Conclusion: The findings of this study indicated that there are deficits in triage knowledge and skills of NGNs' working in the ED of the emergency hospital. With these findings it is therefore imperative to establish proper triage training program that will help to establish and improve NGNs' knowledge and skills on triaging in emergency hospital.

International Journal of Nursing Science, 2014

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) represent a major burden fo... more Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) represent a major burden for patients and health care systems. It results in increased patient mortality, length of hospital stay, and healthcare costs. The clinical pathway for hospitalized patients suffering from AECOPD is poorly established, although a clinical pathway is an integral part of total quality management. Hence, the aim of this study is to evaluate the effect of implementing a clinical pathway on the clinical outcomes in the management of patients with acute exacerbations of chronic obstructive pulmonary disease. A quasi experimental research design was utilized during the current study and it was conducted on 60 adult patients at the Respiratory Intensive Care Unit of Mansoura Main University Hospital. The patients were divided into two groups (control and study group) 30 patients in each. The control group: non-clinical pathway group "non-CP group" involved patients receiving the routine management regimen while the study group: clinical pathway group "CP group" involved patients who received management according to the clinical pathway. Clinical outcomes were evaluated by comparing the length of ICU stay, dyspnea level, anxiety level, pulmonary function tests and ABG values. The findings of this study revealed that patients in the CP group had significantly shorter length of stay than the non-CP group with mean 4.73 day versus 7.83 day p= 0.00.The mean dyspnea score declined from admission to discharge for the CP group from (8.2±1.6) to (0.4± 0.5) compared with (7.9±1.7) to (3.1±1.3) for the non-CP group. On discharge the differences between the two groups were statistically significant p=0.00. Also the mean anxiety score significantly decreased from admission to discharge for the CP group from (3±0.0) to (1.1± 3.0) compared with (2.9± 0.18) to (2.2±0.6) for the non-CP group p=0.00. Moreover, there was a significance difference between the CP group and non-CP group on discharge regarding pulmonary function tests and ABG values. The findings indicated that COPD patients with acute exacerbations can be effectively managed using a clinical pathway. The established pathway achieved its goal of decreasing patient's length of stay, improving dyspnea and anxiety levels, improving pulmonary function test and improving the arterial blood gases.

Nursing in critical care, Aug 1, 2022

Alexandria Scientific nursing journal, Sep 1, 2022

Background: Management of the endotracheal tube cuff pressure is an important part of the care gi... more Background: Management of the endotracheal tube cuff pressure is an important part of the care given by critical care nurses for critically ill patients. Over-inflation of the endotracheal tube cuff can cause serious injury and affects blood flow to tracheal mucosa. Under-inflation may cause air leakage which decreases the effect of mechanical ventilation and increases the risk of pulmonary aspiration and accidental extubation. Changes in the patient's position can cause variation in endotracheal tube cuff pressure. Objective: to identify the relationship between body position and endotracheal tube cuff pressures among critically ill patients.

IOSR Journal of Nursing and Health Science, 2016

Background: The judicious and appropriate use of analgesic/sedative medications is an essential g... more Background: The judicious and appropriate use of analgesic/sedative medications is an essential goal of providing safe and effective nursing management for mechanically ventilated patients. One method of achieving this goal is the use of evidence based guidelines. Although numerous researches have been conducted to explore the clinical benefits of nurse managed-sedation protocol/guidelines, none of them was conducted in Egypt. Aim: This study aimed to develop evidence based analgo-sedation guidelines for adult mechanically ventilated patients. Methods: A methodological research design was utilized according to the Scottish Intercollegiate Guidelines Network (SIGN) process of guidelines development. The present study was conducted on three phases i.e. observation phase, developing guidelines phase and guidelines appraisal phase. The observation phase was conducted on forty patients to better understand how routine analgesia/sedation practices provided by critical care nurses (CCNs) influenced patients' clinical outcomes. Also, the results of this phase were served as a basis for the elaboration of the intended analgo-sedation guidelines. The study was conducted at trauma adult ICU of Emergency Hospital of Mansoura University, Egypt. Two tools were used for data collection: Analgesia/sedation assessment record and Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument that was used for appraising the developed guidelines. Results: Unsatisfactory nursing analgesia/sedation practices were found during the observational phase which had negative effects on patients' clinical outcomes. In response to these findings, the authors developed analgosedation guidelines that included fifty recommendations. The overall quality of intended guidelines was relatively good. The majority of academic nursing appraisers as well as two thirds of academic medical appraisers recommended the current analgo-sedation guidelines to be used in practice without modifications. Conclusions: The observational phase findings of the current study provide additional rationale for the application of standardized approach in analgesia/sedation management for mechanically ventilated patients. The developed guidelines may be a first step in a patient-safety initiative for sedating mechanically ventilated patients in Egypt. It was strongly recommended by the appraisers to incorporate these guidelines in clinical practice as a routine of unit care.

Journal of Nursing Education and Practice, 2015

Background: Patient communication is one of the most important factors associated with quality of... more Background: Patient communication is one of the most important factors associated with quality of care and patient safety, especially in Intensive Care Units (ICUs). However, relatively little is known about the different aspects of communication with unconscious patients, and the effect of communication and outcome measures. Aim: This study aimed to examine effects of implementing structured communication messages (SCMs) on the clinical outcomes of unconscious patients. Methods: A quasi-experimental design was utilized. Sixty unconscious patients were selected from three ICUs of Emergency Hospital of Mansoura University and two ICUs at Main Hospital of Mansoura University. Patients were randomly allocated into two groups (intervention and control group) 30 patients in each. Four tools were used for data collection: physiological adverse events (PAE) assessment tool including (hyperthermia, hypothermia, tachycardia, bradycardia, hypertension, hypotension, hypovolemia, hypervolemia, desaturation, bradypnea, ventilatory distress, hyperglycemia or hypoglycemia), Full Outline of Un-Responsiveness (FOUR) scale, Behavioural Pain Scale (BPS), and Motor Activity Assessment Scale (MAAS). Results: The implementation of SCMs was associated with a decreased incidence of PAE and a statistically significant positive effect on level of consciousness revealed by FOUR scale. Patients in the intervention group maintained in MAAS level (2-3) (calm, cooperative and responsive to touch). The BPS in intervention group significantly decreased following the application of SCMs than control group. Moreover, the mean duration of mechanical ventilation and length of stay in ICU were significantly shorter in the intervention group than in the control group. Conclusions: The SCMs developed, has been shown to facilitate the communication with the unconscious patients therefore, it is recommended for use in a nurse's daily routine of unconscious patients.

Alexandria Scientific nursing journal, Mar 1, 2022

Background: Endotracheal intubation and mechanical ventilation are essential lifesaving procedure... more Background: Endotracheal intubation and mechanical ventilation are essential lifesaving procedures for many critically ill patients. Tracheal intubation with a cuffed tube is considered definitive airway management in adults. The tube cuff is designed to provide a seal against aspiration and to prevent leaks during positive pressure ventilation. A cuff pressure between 20 and 30 cmH2O has been proposed guideline published by the Royal College of Anaesthetists to prevent the complications of over/under inflation of the cuff. Objective: To compare the endotracheal tube cuff pressure measurements before and after nursing interventions among mechanically ventilated patients. Settings: The study was carried out in the general ICU at Damanhour Medical National Institute that consist of three main halls with fifteen beds; hall I (4 beds), hall II (4 beds), and hall III (8 beds).. Subjects: A convenient sample of 70 adult patients who were mechanically-ventilated via an endotracheal tube with high-volume low-pressure cuff and a diameter ranging from 7-8.5 mm were included in the study. Tools: one tool was developed by the researcher used for data collection namely "Endotracheal tube cuff pressure measurement record". It was used to record the endotracheal tube cuff pressure measurements before and after the selected nursing interventions. It consists of three parts. Cuff pressure was assessed before nursing interventions and after nursing interventions. Results: The majority of the studied sample was male with age 51-60 years. Results of the study showed that there was a significant decrease in the mean values of endotracheal cuff pressure starting before till 30 minutes after the complete bed bath, oral hygiene, and right and left lateral positioning procedures. Conversely in the endotracheal suctioning, the mean value of ETT cuff pressure before showed an increase immediately after, followed by a decrease after 15 minutes, then an increase after 30 minutes. Conclusion: The study concluded that the cuff pressure measurements were significantly changed after performing the selected nursing interventions at different timing. Recommendations: Conducting educational program for the ICU nurses to indicate the importance of the endotracheal tube cuff pressure measurement after performing each of selected nursing interventions.

Mansoura Nursing Journal, 2015

Triage is one of the most important managerial and decision making concepts in emergency, it brin... more Triage is one of the most important managerial and decision making concepts in emergency, it brings the most benefit to the greatest number of patients. Triage is important for redistributing and reducing waiting times and enhancing patient and family satisfaction and improving the quality of health care. Therefore, the aim of this study to determine the effect of implementing triage training competencies on newly graduated nurses (NGNs') working in emergency department (ED) at emergency hospital. Patients and Methods: A quasi experimental research design was utilized during the current study and it was conducted on 50 NGNs' who have a bachelor degree of nursing and are involved in providing direct care for emergency patients in the Emergency Hospital at Mansoura University and who are willing to participate in the study was constitute the study sample (study group). While control group of (25 nurses) who have a bachelor degree of nursing and are involved in providing direct care for emergency patients in Talkha Hospital. Results: The mean triage knowledge score increased immediately and post program implementation for the study group from (32.9±1.73 to 32.6±1.78 out of a total score of 35) compared with (13.44±1.78) to (13.52±2.04) for the control group. Also, triage performance increased immediately and post program implementation for the study group from (135.5±4.26 to 134.42±2.41 out of a total score of 140) compared with (56.44±8.21) to (56.76±7.79) for the control group. Moreover, there was a highly statistical significance difference between the study group and control group in relation to NGNs' knowledge and practice in post and two month post program implementation *p = 0.001. While there was no statistical significant difference between study group and control group in pre program implementation. Conclusion: The findings of this study indicated that there are deficits in triage knowledge and skills of NGNs' working in the ED of the emergency hospital. With these findings it is therefore imperative to establish proper triage training program that will help to establish and improve NGNs' knowledge and skills on triaging in emergency hospital.

International Journal of Nursing Science, 2014

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) represent a major burden fo... more Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) represent a major burden for patients and health care systems. It results in increased patient mortality, length of hospital stay, and healthcare costs. The clinical pathway for hospitalized patients suffering from AECOPD is poorly established, although a clinical pathway is an integral part of total quality management. Hence, the aim of this study is to evaluate the effect of implementing a clinical pathway on the clinical outcomes in the management of patients with acute exacerbations of chronic obstructive pulmonary disease. A quasi experimental research design was utilized during the current study and it was conducted on 60 adult patients at the Respiratory Intensive Care Unit of Mansoura Main University Hospital. The patients were divided into two groups (control and study group) 30 patients in each. The control group: non-clinical pathway group "non-CP group" involved patients receiving the routine management regimen while the study group: clinical pathway group "CP group" involved patients who received management according to the clinical pathway. Clinical outcomes were evaluated by comparing the length of ICU stay, dyspnea level, anxiety level, pulmonary function tests and ABG values. The findings of this study revealed that patients in the CP group had significantly shorter length of stay than the non-CP group with mean 4.73 day versus 7.83 day p= 0.00.The mean dyspnea score declined from admission to discharge for the CP group from (8.2±1.6) to (0.4± 0.5) compared with (7.9±1.7) to (3.1±1.3) for the non-CP group. On discharge the differences between the two groups were statistically significant p=0.00. Also the mean anxiety score significantly decreased from admission to discharge for the CP group from (3±0.0) to (1.1± 3.0) compared with (2.9± 0.18) to (2.2±0.6) for the non-CP group p=0.00. Moreover, there was a significance difference between the CP group and non-CP group on discharge regarding pulmonary function tests and ABG values. The findings indicated that COPD patients with acute exacerbations can be effectively managed using a clinical pathway. The established pathway achieved its goal of decreasing patient's length of stay, improving dyspnea and anxiety levels, improving pulmonary function test and improving the arterial blood gases.

Nursing in critical care, Aug 1, 2022

Alexandria Scientific nursing journal, Sep 1, 2022

Background: Management of the endotracheal tube cuff pressure is an important part of the care gi... more Background: Management of the endotracheal tube cuff pressure is an important part of the care given by critical care nurses for critically ill patients. Over-inflation of the endotracheal tube cuff can cause serious injury and affects blood flow to tracheal mucosa. Under-inflation may cause air leakage which decreases the effect of mechanical ventilation and increases the risk of pulmonary aspiration and accidental extubation. Changes in the patient's position can cause variation in endotracheal tube cuff pressure. Objective: to identify the relationship between body position and endotracheal tube cuff pressures among critically ill patients.

IOSR Journal of Nursing and Health Science, 2016

Background: The judicious and appropriate use of analgesic/sedative medications is an essential g... more Background: The judicious and appropriate use of analgesic/sedative medications is an essential goal of providing safe and effective nursing management for mechanically ventilated patients. One method of achieving this goal is the use of evidence based guidelines. Although numerous researches have been conducted to explore the clinical benefits of nurse managed-sedation protocol/guidelines, none of them was conducted in Egypt. Aim: This study aimed to develop evidence based analgo-sedation guidelines for adult mechanically ventilated patients. Methods: A methodological research design was utilized according to the Scottish Intercollegiate Guidelines Network (SIGN) process of guidelines development. The present study was conducted on three phases i.e. observation phase, developing guidelines phase and guidelines appraisal phase. The observation phase was conducted on forty patients to better understand how routine analgesia/sedation practices provided by critical care nurses (CCNs) influenced patients' clinical outcomes. Also, the results of this phase were served as a basis for the elaboration of the intended analgo-sedation guidelines. The study was conducted at trauma adult ICU of Emergency Hospital of Mansoura University, Egypt. Two tools were used for data collection: Analgesia/sedation assessment record and Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument that was used for appraising the developed guidelines. Results: Unsatisfactory nursing analgesia/sedation practices were found during the observational phase which had negative effects on patients' clinical outcomes. In response to these findings, the authors developed analgosedation guidelines that included fifty recommendations. The overall quality of intended guidelines was relatively good. The majority of academic nursing appraisers as well as two thirds of academic medical appraisers recommended the current analgo-sedation guidelines to be used in practice without modifications. Conclusions: The observational phase findings of the current study provide additional rationale for the application of standardized approach in analgesia/sedation management for mechanically ventilated patients. The developed guidelines may be a first step in a patient-safety initiative for sedating mechanically ventilated patients in Egypt. It was strongly recommended by the appraisers to incorporate these guidelines in clinical practice as a routine of unit care.

Journal of Nursing Education and Practice, 2015

Background: Patient communication is one of the most important factors associated with quality of... more Background: Patient communication is one of the most important factors associated with quality of care and patient safety, especially in Intensive Care Units (ICUs). However, relatively little is known about the different aspects of communication with unconscious patients, and the effect of communication and outcome measures. Aim: This study aimed to examine effects of implementing structured communication messages (SCMs) on the clinical outcomes of unconscious patients. Methods: A quasi-experimental design was utilized. Sixty unconscious patients were selected from three ICUs of Emergency Hospital of Mansoura University and two ICUs at Main Hospital of Mansoura University. Patients were randomly allocated into two groups (intervention and control group) 30 patients in each. Four tools were used for data collection: physiological adverse events (PAE) assessment tool including (hyperthermia, hypothermia, tachycardia, bradycardia, hypertension, hypotension, hypovolemia, hypervolemia, desaturation, bradypnea, ventilatory distress, hyperglycemia or hypoglycemia), Full Outline of Un-Responsiveness (FOUR) scale, Behavioural Pain Scale (BPS), and Motor Activity Assessment Scale (MAAS). Results: The implementation of SCMs was associated with a decreased incidence of PAE and a statistically significant positive effect on level of consciousness revealed by FOUR scale. Patients in the intervention group maintained in MAAS level (2-3) (calm, cooperative and responsive to touch). The BPS in intervention group significantly decreased following the application of SCMs than control group. Moreover, the mean duration of mechanical ventilation and length of stay in ICU were significantly shorter in the intervention group than in the control group. Conclusions: The SCMs developed, has been shown to facilitate the communication with the unconscious patients therefore, it is recommended for use in a nurse's daily routine of unconscious patients.