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Elyasi E, Khatiban M, Mohammadi Y, Shamsizadeh M. The Impact of an ICU Liaison nurse Program on Physiological Parameter and Level of Consciousness in Discharging Patients in the Intensive Care Unit: A Randomized Clinical Trial. Avicenna J Nurs Midwifery Care 2020; 28 (3) :227-238
URL: http://nmj.umsha.ac.ir/article-1-2031-en.html
The Impact of an ICU Liaison nurse Program on Physiological Parameter and Level of Consciousness in Discharging Patients in the Intensive Care Unit: A Randomized Clinical Trial
Ensieh Elyasi1 , Mahnaz Khatiban2 , Younes Mohammadi3 , Morteza Shamsizadeh * 4
1- Student Research Committee, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
2- Professor, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
3- Associate Professor, Department of Epidemiology, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
4- Instructor, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran , mortezashamsizadeh@gmail.com
Keywords: Liaison nurse, Physiological indices, Intensive care unit, Level of consciousness
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Introduction

Patients transferred from ICU to general ward need a higher level of nursing attention and care than other patients admitted to the ward. Liaison nursing is a modern and practical clinical care that has been formed in recent decades due to the increase of care techniques. This type of care has been called "wall-free intensive care" (12). The liaison nurse expands nursing services for patients and facilitates the care for patients while being transferred to a different ward (13).The aim of this study was to investigate the effect of the role of the liaison nurse on physiological indicators and the level of consciousness of patients transferred from the intensive care unit.

 

Materials and Methods


The present article is the result of a two-group clinical trial that was performed on 90 patients admitted to the special and general wards of Besat Hospital in Hamadan, Iran. Available sampling and patients were randomly assigned to the two groups. The control group received routine care and in the intervention group was visited twice a day by the liaison nurse for up to three days. The instrument used was a checklist of physiological indices and the GCS scale. Data analysis method: Descriptive statistics, mean and standard deviation for quantitative and frequency data and frequency percentage for qualitative data are used to analyze the data. Also, independent t-test and paired t-test and chi-square test were used by SPSS software version 16 (SPSS Inc., Chicago, Ill., USA).


 

Results

There was no significant difference between the demographic and clinical characteristics of the two groups at the beginning of the study. After the intervention of the intensive care unit nurse, the two groups were not significantly different in terms of physiological parameters and level of consciousness (P> 0.05).

Table 1. Comparison of the frequency distribution of day care in the control and intervention groups
Type of care
 		 Intervention Control Chi-square
N % N %
Oral care 45 100.0 45 100.0 X2=   0 df =   1P=0.99
Personal hygiene 45 100.0 45 100.0 X2=     0 df = 1, P=0.99
Foley catheter 45 100.0 45 100.0 X2=    0 df = 1, P=0.99
Gastric catheter 5 11.1 5 11.1 X2= 0.00df =1, P=0.99
Tracheostomy 2 4.4 3 6.7 X2= ، 0.212df =1, P=0.654
Colostomy 2 4.4 0 0.0 X2= ، 2.045df =1, P=0.153
Bandage 39 86.7 39 86.7 X2= ، 0.00df =1, P=0.99
Suture 40 88.9 39 86.7 X2= ، 0.104df =1, P=0.748
Drain 2 4.4 14 31.1 X2= ، 10.946df =1, P=0.001
Traction 4 8.9 3 6.7 X2= ، 0.155df =1, P=0.694
Splint or plaster 7 15.6 5 11.1 X2= ، 0.385df =1, P=0.535
Chest tube 8 17.8 12 26.7 X2= ، 1.029df =1, P=0.310
Bedsore 0 0.0 2 4.4 X2= ، 2.045df =1, P=0.153
Respiratory physiotherapy 43 95.6 43 95.6 X2= ، 0.00df =1, P=0.99
Organ Physiotherapy 7 15.6 12 26.7 X2= ، 1.668df =1, P=0.197

 
Table 2. Comparison of mean and standard deviation of patients' physiological parameters before transferring from ICU to general wards in two intervention groups
             Group
 
Variables		 Control Intervention-test T-test
M SD M SD
Systolic blood pressure (100-140) mmHg 118.822 18.412 117.488 10.428 0.42T=
P-value=0.674
Diastolic blood pressure
(90-60) mm Hg		 69.96 11.18 70.60 8.29 T=0.31
P-value=0.757
Moderate blood pressure
(90-70) mm Hg		 86.27 12.02 85.69 8.48 T= 0.26-
P-value=0.793
Heart rate
(60-100 / minute)		 86.22 15.26 88.24 11.91 T=0.562
P-value=0.575
Number of breaths
(20-12 / minute)		 16.78 0.97 15.76 0.74 T= 5.60-
P-value=0.001
Temperatures
(36.5-37.2°C)		 37.15 0.32 37.02 0.14 T= 2.36-
P-value= 0.020
SO2 (92-99%) 93 0.02 95 0.01 T= 4.74
P-value= 0.426
 
Table 3. Comparison of mean and standard deviation of patients' physiological indices at the end of the study in two intervention groups
                Groups
 
 
Variables		 Control Intervention-test T-test
M SD M SD
Systolic blood pressure (100-140) mmHg 121.844 18.492 119.356 15.669 0.689T=
df= 88
P-value=0.493
Diastolic blood pressure
(90-60) mm Hg		 72.111 10.820 72.000 9.966 T= 0.054
P-value=0.957
Moderate blood pressure
(90-70) mm Hg		 88.133 11.169 87.391 10.820 T= 0.320-
P-value=0.750
Heart rate
(60-100 / minute)		 87.622 14.632 88.156 11.186 T= 0.194
P-value=0.846
Number of breaths
(20-12 / minute)		 16.800
 		 0.894 16.911
 		 0.900 T=0.587
P-value=0.558
Temperatures
(36.5-37.2°C)		 37.078 0.297 37.167 0.298 T= 1.388
P-value= 0.169
SO2 (92-99%) 0.936 0.018 0.937 0.024 T= 0.151
P-value= 0.880


Table 4. Comparison of mean and standard deviation of patients' level of consciousness in the two groups of control and intervention
Variable Control Intervention-test T-test
M SD M SD  
1.082- T=
df= 88
P-value=0.282
GCS
 		 Before transferring 15.044 5.724 14.088 1.534
After transferring 14.266 1.572 14.733 0.939 T=1.709
df =88
P-value=0.091
FOUR Before transferring 15.644 0.933 15.533 1.516 T= 0.419-
Df= 88
P-value=0.677
After transferring 15.444 6.133 15.755 1.090 T= 0.742-
df=88
P-value=0.460s

Discussion


Hospital caregivers in this study were mostly first-degree family members (parents, spouse, siblings, and children). All caregivers were the same gender as the patient and most caregivers in both groups were their children. Most caregivers did not live in the same place with the patient. Other demographic characteristics of caregivers in this study were similar in the two groups.
Both groups were the same in terms of age distribution. Most of the participants in the study were male. 68.9% were in the control group and 71.1% in the intervention group. Most of the patients in both groups were married and lived in a city. There was no significant difference in terms of education. The highest reason for hospitalization in both groups was due to trauma and surgery. The mean hospitalization in the intervention group was 7.26 and in the control group was 8.95 and the mean of intubation in the intervention group was 8.14 days and in the control group was 9.84 days.
Findings showed that the liaison nurse has no significant effect on hemodynamic parameters and level of consciousness in patients transferred from the intensive care unit. This finding is in conflict with previous studies on the effects of the role of a liaison nurse (9, 25)
According to the obtained results, this hypothesis is rejected and the liaison nurse has no effect on physiological parameters. These findings were in line with some previous studies on the effects of the liaison nurse’s role. Various studies have been performed on the liaison nurse and patients admitted and transferred from the intensive care unit, but the same result has not always been obtained. Consistent with current findings, a study by Williams et al. (2010) in Australia evaluating the caregiver's care in discharging patients from the intensive care unit showed that ICU's training and intensive care services had an effect on readmission and there was no long stay in the intensive care unit (25).
Accordingly, on a larger scale, the role of liaison nurses is more significant because in such circumstances it is possible to provide specialized care to a larger number of patients. This was the first study in Hamadan; accordingly, one of the limitations of the study was the unfamiliarity of nurses and study managers with coordination with this role. In addition, in this study, post-ICU intensive care was performed by only one liaison nurse for a short period of time. The number of samples and the study interval were also small, which may affect the results.

 

Conclusion

In nursing services, the interface is not effective on physiological indicators and level of consciousness in patients transferred from the intensive care unit to the general ward. Further studies in this area are recommended.

 

Acknowledgments

The authors thank the nurses of the intensive care unit and the general ward and the people who participated in this study. Also, permission has been obtained from the ethics committee of Hamadan University of Medical Sciences, with the code IR.UMSHA.REC.1396.411 and the study has been registered in the Clinical Trial Center of Iran, with the code IRCT20160110025929N12.

 

Conflicts of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

 

Type of Study: Original Research | Subject: Nursing
Received: 2019/02/20 | Accepted: 2019/05/6 | Published: 2020/01/17
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