Volume 28, Issue 3 (7-2020)                   Avicenna J Nurs Midwifery Care 2020, 28(3): 227-238 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

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
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
Persian Full-Text [PDF 521 kb]   (789 Downloads)     |   Abstract (HTML)  (4722 Views)
Extended Abstract:   (422 Views)

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).



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
Control Intervention-test T-test
Systolic blood pressure (100-140) mmHg 118.822 18.412 117.488 10.428 0.42T=
Diastolic blood pressure
(90-60) mm Hg
69.96 11.18 70.60 8.29 T=0.31
Moderate blood pressure
(90-70) mm Hg
86.27 12.02 85.69 8.48 T= 0.26-
Heart rate
(60-100 / minute)
86.22 15.26 88.24 11.91 T=0.562
Number of breaths
(20-12 / minute)
16.78 0.97 15.76 0.74 T= 5.60-
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
Control Intervention-test T-test
Systolic blood pressure (100-140) mmHg 121.844 18.492 119.356 15.669 0.689T=
df= 88
Diastolic blood pressure
(90-60) mm Hg
72.111 10.820 72.000 9.966 T= 0.054
Moderate blood pressure
(90-70) mm Hg
88.133 11.169 87.391 10.820 T= 0.320-
Heart rate
(60-100 / minute)
87.622 14.632 88.156 11.186 T= 0.194
Number of breaths
(20-12 / minute)
0.894 16.911
0.900 T=0.587
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
1.082- T=
df= 88
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
FOUR Before transferring 15.644 0.933 15.533 1.516 T= 0.419-
Df= 88
After transferring 15.444 6.133 15.755 1.090 T= 0.742-


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.



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.



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

1. Urden LD, Stacy KM, Lough ME. Critical Care Nursing-E-Book: Diagnosis and Management: Elsevier Health Sciences; 2017.
2. Falk A-C, Wallin E-M. Quality of patient care in the critical care unit in relation to nurse patient ratio: A descriptive study. Intensive and Critical Care Nursing. 2016;35:74-9. [DOI:10.1016/j.iccn.2016.01.002] [PMID]
3. Tan SS, Bakker J, Hoogendoorn ME, Kapila A, Martin J, Pezzi A, et al. Direct cost analysis of intensive care unit stay in four European countries: applying a standardized costing methodology. Value in Health. 2012;15(1):81-6. [DOI:10.1016/j.jval.2011.09.007] [PMID]
4. Corrêa TD, Ponzoni CR, Rabello Filho R, Neto AS, de Freitas Chaves RC, Pardini A, et al. Nighttime intensive care unit discharge and outcomes: A propensity matched retrospective cohort study. PloS one. 2018;13(12):e0207268. [DOI:10.1371/journal.pone.0207268] [PMID] [PMCID]
5. Häggström M, Asplund K, Kristiansen L. How can nurses facilitate patient's transitions from intensive care?: a grounded theory of nursing. Intensive and critical care nursing. 2012;28(4):224-33. [DOI:10.1016/j.iccn.2012.01.002] [PMID]
6. Stelfox HT, Perrier L, Straus SE, Ghali WA, Zygun D, Boiteau P, et al. Identifying intensive care unit discharge planning tools: protocol for a scoping review. BMJ open. 2013;3(4):e002653. [DOI:10.1136/bmjopen-2013-002653] [PMID] [PMCID]
7. Schofield-Robinson OJ, Lewis SR, Smith AF, McPeake J, Alderson P. Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors. The Cochrane database of systematic reviews. 2018;11:Cd012701. [DOI:10.1002/14651858.CD012701.pub2] [PMCID]
8. So HM, Yan WW, Chair SY. A nurse-led critical care outreach program to reduce readmission to the intensive care unit: A quasi-experimental study with a historical control group. Australian Critical Care. 2018. [DOI:10.1016/j.aucc.2018.11.005] [PMID]
9. Endacott R, Chaboyer W, Edington J, Thalib L. Impact of an ICU Liaison Nurse Service on major adverse events in patients recently discharged from ICU. Resuscitation. 2010;81(2):198-201. [DOI:10.1016/j.resuscitation.2009.10.011] [PMID]
10. Chaboyer W, Thalib L, Foster M, Ball C, Richards B. Predictors of adverse events in patients after discharge from the intensive care unit. American Journal of Critical Care. 2008;17(3):255-63. [DOI:10.4037/ajcc2008.17.3.255] [PMID]
11. Chaboyer W, Lin F, Foster M, Retallick L, Panuwatwanich K, Richards B. Redesigning the ICU nursing discharge process: a quality improvement study. Worldviews on Evidence‐Based Nursing. 2012;9(1):40-8. [DOI:10.1111/j.1741-6787.2011.00234.x] [PMID]
12. Chaboyer W, Gillespie B, Foster M, Kendall M. The impact of an ICU liaison nurse: a case study of ward nurses' perceptions. Journal of clinical nursing. 2005;14(6):766-75. [DOI:10.1111/j.1365-2702.2005.01141.x] [PMID]
13. Alberto L, Zotárez H, Cañete ÁA, Niklas JEB, Enriquez JM, Gerónimo MR, et al. A description of the ICU liaison nurse role in Argentina. Intensive and Critical Care Nursing. 2014;30(1):31-7. [DOI:10.1016/j.iccn.2013.07.001] [PMID]
14. Hesselink G, Zegers M, Vernooij-Dassen M, Barach P, Kalkman C, Flink M, et al. Improving patient discharge and reducing hospital readmissions by using Intervention Mapping. BMC health services research. 2014;14(1):389. [DOI:10.1186/1472-6963-14-389] [PMID] [PMCID]
15. McIntyre T, Taylor C, Eastwood GM, Jones D, Baldwin I, Bellomo R. A survey of ward nurses attitudes to the Intensive Care Nurse Consultant service in a teaching hospital. Australian Critical Care. 2012;25(2):100-9. [DOI:10.1016/j.aucc.2011.10.003] [PMID]
16. Adam S, Osborne S, Welch J. Critical care nursing: science and practice: Oxford University Press; 2017. [DOI:10.1093/med/9780199696260.001.0001] [PMID]
17. Stelfox HT, Lane D, Boyd JM, Taylor S, Perrier L, Straus S, et al. A scoping review of patient discharge from intensive care: opportunities and tools to improve care. Chest. 2015;147(2):317-27. [DOI:10.1378/chest.13-2965] [PMID]
18. Fry M. Literature review of the impact of nurse practitioners in critical care services. Nursing in critical care. 2011;16(2):58-66. [DOI:10.1111/j.1478-5153.2010.00437.x] [PMID]
19. Choi J, Tate JA, Rogers MA, Donahoe MP, Hoffman LA. Depressive symptoms and anxiety in intensive care unit (ICU) survivors after ICU discharge. Heart & Lung: The Journal of Acute and Critical Care. 2016;45(2):140-6. [DOI:10.1016/j.hrtlng.2015.12.002] [PMID] [PMCID]
20. Dolatyari A, Sharififar S, ZAREIYAN A, TADRISI SD. Family satisfaction with care in the intensive care unit: Results of a multiple center study in selected military hospitals. 2014. [DOI:10.18869/acadpub.mcs.1.1.18]
21. Rosa R, Ascoli A, Rutzen W, Madeira L, Falavigna M, Robinson C, et al. Factors associated with hospital anxiety and depression among ICU survivors: a cross sectional study. Intensive care medicine experimental. 2015;3(S1):A369. [DOI:10.1186/2197-425X-3-S1-A369] [PMCID]
22. Niven DJ, Bastos JF, Stelfox HT. Critical care transition programs and the risk of readmission or death after discharge from an ICU: a systematic review and meta-analysis. Critical care medicine. 2014;42(1):179-87. [DOI:10.1097/CCM.0b013e3182a272c0] [PMID]
23. Day A, Haj-Bakri S, Lubchansky S, Mehta S. Sleep, anxiety and fatigue in family members of patients admitted to the intensive care unit: a questionnaire study. Critical Care. 2013;17(3):R91. [DOI:10.1186/cc12736] [PMID] [PMCID]
24. McAdam JL, Fontaine DK, White DB, Dracup KA, Puntillo KA. Psychological symptoms of family members of high-risk intensive care unit patients. American journal of critical care : an official publication, American Association of Critical-Care Nurses. 2012;21(6):386-93; quiz 94. [DOI:10.4037/ajcc2012582] [PMID]
25. Williams TA, Leslie G, Finn J, Brearley L, Asthifa M, Hay B, et al. Clinical effectiveness of a critical care nursing outreach service in facilitating discharge from the intensive care unit. American Journal of Critical Care. 2010;19(5):e63-e72. [DOI:10.4037/ajcc2010965] [PMID]
26. Forum AILN. Uptake and caseload of intensive care unit liaison nurse services in Australia. Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine. 2012;14(3):221.
27. Caffin CL, Linton S, Pellegrini J. Introduction of a liaison nurse role in a tertiary paediatric ICU. Intensive and Critical Care Nursing. 2007;23(4):226-33. [DOI:10.1016/j.iccn.2006.12.001] [PMID]
28. Elliott M, Worrall-Carter L, Page K. Factors contributing to adverse events after ICU discharge: a survey of liaison nurses. Australian Critical Care. 2013;26(2):76-80. [DOI:10.1016/j.aucc.2012.07.005] [PMID]
29. Green A, Edmonds L. Bridging the gap between the intensive care unit and general wards-the ICU Liaison Nurse. Intensive and Critical Care Nursing. 2004;20(3):133-43. [DOI:10.1016/S0964-3397(04)00024-2]
30. O'sullivan A, Boyd B, O'shaughnessy M, MacIntyre A, Begley C. Evaluation of the introduction of a postnatal ward liaison neonatal nurse. Journal of Neonatal Nursing. 2015;21(1):34-9. [DOI:10.1016/j.jnn.2014.07.003]
31. Doric A, Ernest D, Thalib L, Page KN, Chaboyer W, Eliott S, et al. The impact of an ICU liaison nurse service on patient outcomes. Critical Care and Resuscitation. 2008;10(4):296.
32. Tabanejad Z, Pazokian M, Ebadi A. The Effect of Liaison Nurse Service on Patient Outcomes after Discharging From ICU: a Randomized Controlled Trial. Journal of caring sciences. 2016;5(3):215. [DOI:10.15171/jcs.2016.023] [PMID] [PMCID]

Add your comments about this article : Your username or Email:

Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2023 CC BY-NC 4.0 | Avicenna Journal of Nursing and Midwifery Care

Designed & Developed by : Yektaweb