الفهرس 
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Abstract
Caring of the mechanically ventilated patient is a fundamental component of a nurse’s clinical practice in ICUs. This care requires prompt and accurate decisions so that life-protecting and lifesaving therapy can be appropriately applied. Nursing management of the mechanically ventilated patient is challenging on many levels from the acquisition of highly technical skills, expert knowledge on invasive monitoring and implementation of interventions to care for the patients.
Clustered nursing interventions are clustering several routine or nursing care events together rather than spacing them out over time and also theyare defined as group of interventions more than six interventions for each patient in one nursing interaction. Critical care nurses are responsible for providing care for critically ill patients. Nursing-specific interventions including assessment, administering medications, suctioning, repositioning, hygiene, oral care, bath, incontinence care, wound care, range-of-motion exercises, linen change, weighing application of splints or binders, and/or others. Thus, critical care nurses monitor physiologic patient parameters on a regular basis to assure the patient’s stability. Clustered nursing interventions may lead to physiological responses alterations that are common prior to the occurrence of these serious adverse events. Therefore, the aim of this study was conducted to determine physiological responses related to clustered nursing interventions among mechanically ventilated patients.
Materials & Method
A descriptive design was used to conduct this study that was carried out in ICUs of Alexandria main university hospital – namely; Casualty ICU (unit I), General ICU (unit III) and Damanhur Medical National Institute hospital namely general ICU of Damanhur Medical National Institute hospital. A convenience sample of 80 adult patients aged 18 years and overreceiving mechanical ventilation was included in the study during the period of data collection from January to April 2016. Patients who had pulmonary disorders and pregnancy were excluded from the sample.
Two tools were used to collect the data of this study. Tool one: ”Physiological Response Measurement” and tool two: ”Clustered Nursing Interventions Assessment Record.” Both of them were developed by the researcher after reviewing the relevant literature. Permission to conduct the study was obtained from hospital responsible authority after explanation of aim of the study and delivery of an official letter from the faculty of nursing. The tools were reviewed by the jury of seven experts in medical specialty and nursing specialty for face and content validity.
Patients` physiological responses were assessed such as (heart rate and rhythm, respiratory rate, blood pressure, body temperature, oxygen saturation and end tidal carbon dioxide) were measured at different points: (Before starting any procedure for 5 min as a baseline,5min after starting of any procedures, 10 min during the procedures, Immediately after the end of procedures and measuring the physiological response 15min after the procedures performed) using tool I. Clustered nursing interventions were recorded using tool IIand included:(The type, number, start time and duration of nursing interventions which was provided by the nurse in providing direct care for those patients). In addition to, patient`s socio-demographic data was developed by the researcher to collect data such as age, sex, diagnosis, duration of mechanical ventilation and length of stay in ICU.
Results
More than half of patients were male (61.25 %) and (63.75 %) of critically ill patients who were enrolled in the study were less than 60 years old, As regard to length of stay in the intended ICUs, the majority of the patients (41.25 %) stayed more than 2 weeks. According to patient`s duration of mechanical ventilation, more than half of patients (58.75 %) stayed less than 2 weeks. It was found that (35%) of the studied patients suffered from neurological disorders and (20%) from endocrine disorders, while (5%) from other disorders as (toxicology, drowning, and laryngeal carcinoma).
Results of the current study revealed that there was a significant relationship between clustered nursing intervention performance and mean of physiological responses which showed that there was an increased in mean end tidal carbon dioxide immediately after clustered nursing care than before clustered nursing care and after 15min from clustered nursing intervention performed. Also, there was decreased mean oxygen saturation immediately after clustered nursing care than before clustered nursing care and after 15min from clustered nursing intervention performed.
On the other hand, results of the current study revealed also that mean respiratory rate increased and then decreased immediately after clustered nursing care than before clustered nursing care and after 15min from clustered nursing intervention performed. In relation to mean heart rate, it increased immediately after clustered nursing care than before clustered nursing care and after 15min from clustered nursing intervention performed. As well, increased mean systolic blood pressure immediately after clustered nursing care than before clustered nursing care and after 15min from clustered nursing intervention performed.
The current study demonstrated that the most of physiological responses affected significantly by number of clustered nursing interventions were mean respiratory rate, mean systolic blood pressure and mean oxygen saturation among different study phases. Additionally, there was a statistical significant relationship exists between duration of certain procedures and physiological responses. On the other hand, results of current study revealed also that there was non-significant relationship between number of clustered nursing interventions performance and patients` outcome (length of stay in ICU & duration of mechanical ventilation).