1. B. P. Koirala Institute of Health Sciences, Dharan Nepal
APPLICATION FORMAT FOR RESEARCH GRANT
Section–A
1. Title of the research project:
Strengthening Knowledge and Practices Regarding Life
Support Measures among the Nurses Working in
Emergency Unit of BPKIHS
2. Name and designation of:
a. Principal investigator:
Name:
Designation: Assistant Professor, Medical-Surgical Nursing
Department
S.N. Name Designation Department
3. Expected duration of the proposal: 1 Year
4. Amount of grant in – aid asked RS. = 25,000/-
5. This is new project: Yes.

2. Declaration
1. I/we have read the terms and the terms and conditions of
BPKIHS research grants, and agree to abide by them.
2. I/we agree to submit, within three months from the date of
termination of the project, a report on the work done.
3. I/we agree to maintain a stock book for purchases made for he
project. I/we shall submit the complete statement of account
within three months of the termination of the project, and at
any other time as required by the accounts section.
4. I/we agree to acknowledge the grant in any publication
resulting from the project if it is approved for financial
assistance.
5. I/we declare that no research grant is already available for the
research project from any other source.
6. I/we declare that the project will be conducted as per the
highest ethical standards applicable to animal/human
experiments.
Signatures (with seal and date):
Principal Investigator Signature Date
Gayanand Mandal ………………………………………………………
Co-investigator Signature Date
Remarks form the HoD of the Principal Investigator:
Date: Signature & Seal of the
HoD
Remarks for the HoD of the Co-investigator:

3. Section-C
Details of the research project
1. Title of the research project
Strengthening Knowledge and Practices Regarding Life Support
Measures among the Nurses Working in Emergency Unit of BPKIHS
2. Objectives.
1. General Objectives: To find out the knowledge and practices regarding life
support measures among the nurses working in emergency unit of BPKIHS.
Specific Objectives:
1. To find out the knowledge and practices regarding life support measures
among the nurses working in emergency unit of BPKIHS.
2. To find out the association between selected demographic variables with
knowledge and practices.
3. To evaluate the effectiveness of education intervention on life support
measure among the nurses working in emergency unit of BPKIHS.
Null Hypothesis: There will be no difference in knowledge and practices about life
support measures among the nurses working in emergency department after education
intervention.
3. Summary of the research project.
B P Koirala Institute of Health Sciences has 700 bedded tertiary care hospital having
capacity of dealing with all kinds of emergency situation and disaster and polytrauma
victim and is one of the tertiory level of health care in Nepal. Emergency unit may be
thought of as having context (the demographics and characteristics of the kind of
work they do), structure (the grouping of people and the allocation of responsibility
through specialization, expertise, formalization, and some degree of centralization or
decentralization), process (intra organizational relationships such as the flow of
information and coordination), and outcomes (productivity, goal attainment, morale,
and satisfaction of the members). Emergency nursing is that specialty within nursing
that deals specifically with human responses to life-threatening problems. Emergency
nurses account for an estimated 10 % of the total number of nurses working in the
hospital setting. B P Koirala Institute of Health Sciences (BPKIHS) has 700 bedded
tertiary care hospital .Research project is aimed at assessing the knowledge and
practices regarding life support measures among the nurses working in emergency
unit of BPKIHS.
It will be hospital based pre-experimental research design conducted among the
nurses working in emergency unit of BPKIHS.

4. 4. Review of the literature pertaining to the project.
A emergency nurse is responsible for ensuring that acutely and critically ill patients
and their families receive optimal care. Critically ill patients are defined as those
patients who are at high risk for actual or potential life-threatening health problems.
The more critically ill the patient is, the more likely he or she is to be highly
vulnerable, unstable and complex, thereby requiring intense and vigilant nursing
care.1
High intensity fields of work, such as the airline industry and the military, already
employ checklists to decrease errors of omission, improper implementation of
procedures and protocols, and to decrease human error under stressful conditions.
Examples include the prediction of successful weaning from mechanical ventilation in
ICU patients, adherence to evidence-based best practices and in the improvement of
patient safety in many clinical areas.1
As issues relating to patient care become increasingly complex and new technologies
and treatments are introduced, emergency nurses will need to become ever more
knowledgeable. 4 Nurses need to develop a thorough understanding of these modes
including their effects on underlying respiratory physiology to be able to deliver safe
and appropriate patient care.5
Emergency nurses work in a wide variety of settings, filling many roles. They are
bedside clinicians, nurse educators, nurse researchers, nurse managers, clinical nurse
specialists and nurse practitioners. 2 Much information is available on patients’
satisfaction and perceptions of quality of care, and some information is available on
patients’ perceptions of physicians’ skills, little information is available on patients’
perceptions of nurses’ skills. 3
The defining characteristics of good nursing care investigation mostly involved the
demeanor of the nurses: gentle, calm, courteous, kind, attentive, available, empathetic,
and reassuring. Although researchers have described nurses’ attributes that patients
consider when judging nursing quality and good nursing care in general, little is
known of patients’ perceptions specifically of the skill of nurses. 4
Rapid advances in healthcare and technology have contributed to keeping more
people out of the hospital. As issues relating to patient care become increasingly
complex and new technologies and treatments are introduced, emergency and critical
care nurses will need to become ever more knowledgeable. 4
An emergency unit is a specialized section of a hospital that provides comprehensive
and continuous care for persons who are critically ill and who can benefit from
treatment. The purpose of the emergency care unit is simple even though the practice
is complex. Healthcare professionals who work in the emergency provide nursing care
around the clock, intensive monitoring and treatment of patients seven days a week. 1
Patients cared for in emergency include those with severe trauma, major head injury
or coma, respiratory and/or hemodynamic insufficiency, or failure of one or more
organ systems and those with intensive monitoring needs following major surgery.

5. The medical needs of emergency patients are often complex, requiring of caregivers,
who work under stressful conditions, a high degree of knowledge and skill. Despite
the dedication and competency of emergency caregivers, mortality rates for critical
care patients remain high, ranging from 10% to 20%.2 The emergency visit will
provide treatment management, diagnosis, interventions, and individualized care for
each patient recovering from severe illness. 3
Despite tremendous resource utilization, the majority of trauma patients can
eventually return to varying degrees of functional daily living and independence due
to better emergency management. A subgroup of severely injured elderly patients had
a significantly higher mortality rate. However, elderly survivors that entered our
rehabilitation facility fared as well as the younger patients.1
The main feature of emergency unit is the availability of triage system, disaster
management system, continuous monitoring of the cardiac rhythm by
electrocardiography. This allows early intervention with medication, cardio version or
defibrillation, improving the prognosis. 4
5. Rational of the study.
There are no reliable statistics on basic and advanced life support measurses because
no single agency collects information about how many people get CPR, how many do
not get it who needs it, how many people are trained, etc. Brain Adenosine
Triphosphate (ATP) is depleted after 4-6 min of no blood flow. It returns nearly to
normal within 6 min of starting effective BLS. In clinical practice, the severity of the
underlying cardiac disease is the major determining factor in the success or failure of
life support measures attempts. Of those factors under control of the rescuers, poor
outcomes are associated with long arrest time before BLS /ALS is begun, prolonged
Ventricular Fibrillation (VF) without definitive therapy and inadequate coronary and
cerebral perfusion during cardiac massage. Optimum outcome from VF is obtained
only if BLS /ALS is begun within 3-5 min of arrest and defibrillation applied within 8
minutes.5
Several studies have shown the benefit on survival of immediate BLS/ALS, and the
detrimental effect of delay before defibrillation. For every minute without BLS and
ALS, survival from witnessed VF decreases by 7-10%. When bystander ALS is
provided, the decline in survival is more gradual and averages 3-4%. Overall,
bystander BLS and ALS doubles or triples survival from witnessed cardiac arrest.15
In cities, such as Seattle, where CPR training is widespread and defibrillation by
emergency management system (EMS) personnel follows quickly, the survival rate is
about 30%, but in cities such as New York, without these advantages, the survival rate
is only 1-2%.9
Almost half of cardiac deaths occur in the hospital environment and nurses are the
first responders. CPR is a critical component of BLS and ALS and the established
first line of response to a cardiac arrest in the interim before defibrillation and
advanced life support are available.24 Following cardiac arrest, effective BLS/ALS

6. enables enough oxygen to reach the brain to delay brain death and allows the heart to
remain responsive to defibrillation attempts.9
Nurses work in a variety of clinical settings. Some of these areas involve care of
patients with acute illness while others do not. No matter in which setting a nurse
works, the possibility exists that he or she will participate in the resuscitation of a
patient. When patients face a life-threatening event such as cardiopulmonary arrest,
they rely on the competence and skills of the healthcare professionals. Because nurses
are often the healthcare providers closest to the bedside and the first to respond to
patient’s needs, their knowledge and skills need to be optimal and their performance
proficient.16
Nurses have a two-fold role during a cardiac arrest. Firstly, they have a responsibility
to provide BLS and ALS as a holding measure to ensure adequate circulation and
perfusion of vital organs. Secondly, they participate in and often initiate ACLS
measures, which aim to treat or reverse the cause of arrest.13
ALS is a practical skill and needs professional instruction followed up by a regular
practice on a resuscitation manikin to gain and maintain full competency.9 The
development of knowledge and skills is an essential component of professional
development in nurses' career. Undoubtedly, the public expectation is high that nurses
will be competent to perform BLS in the event of cardiac arrest. The issue of nurses'
BLS knowledge and skills remain unexplored within the context of Nepal.
Hence, for the most effective outcomes, hands-on training should be given by an
expert. This will enable the person to perform BLS/ALS more safely and more
effectively. Most organizations advocate regular retraining, in order to keep practice
in the skills and to ensure that the person is up-to-date with the latest guidelines,
which change periodically based on the outputs and governing bodies.9 The above
facts made the investigators interested to study on this topic because BLS/ALS means
life saving procedure. Hence, every nurses need to update their knowledge according
to the current evidence-based guidelines.
1.3 Significance of the Study
· This study may be helpful to find out the training needs of the health workers.
· The findings of the study may be helpful to provide the baseline data to plan
and implement similar type of educational package on ALS.
· This study may be helpful for arranging refreshment courses/ in-service
education regarding ALS regularly for nursing personnel working at different
areas of the hospital.
· This study may help/ save the life of public by nursing staff who are the first
detector of cardiac arrest and the first receiver and provider of immediate BLS
and further management which will ultimately help reduce the mortality rate
of nation due to cardiac arrest.

7. 1.4 Operational Definitions
1. 4.1 Knowledge
It denotes theoretical understanding of nurses regarding life supporting
measures which includes definition of CPR and BLS,ALS , their purposes,
indications , sequence , complications and termination of procedure.
1.4.2 Skills
Nurses’ performance to carry out sequence of BLS/ALS on Anne Manikin
which includes assessment of the victim, maintaining of airway and
breathing, chest compression and rescue breathing.
1.4.3 Nurses
Nurses having at least 3 years of education in Nursing course and working in
emergency department of BPKIHS.
RESEARCH METHODOLOGY
3.1 Design of the Study
Pre-experimental (one group pre-test and post-test design)
O1 × O2
3.2 Research Setting Emergency unit of BPKIHS.
3.3 Sample
All the nurses who work in emergency unit and met the inclusion criteria.
3.5 Sample Size: All staff nurses working in emergency
3.6 Sampling Techniques
Samples will be selected by using Non-Probability Convenience Sampling
Technique.
3.7 Eligibility Criteria
3.7.1 Inclusion Criteria
· All nurses who are working in the emergency department of
BPKIHS.
· Nurses who have completed at least 3 years of formal Certificate
Nursing education.
3.7.2 Exclusion Criteria
· Those who are not willing to participate.

8. 3.8 Research Instrument
A self-administered semi-structured questionnaire will be developed to assess
the knowledge and skill regarding life Support measures as per the objective
of the study. Resuscitation skills were observed and recorded on the
observation checklist prepared by the investigators.
The tool consists of three parts:
Part I:
It will consists of socio-demographic data of the nurses, including their
training experiences and their exposure (witness, assistance and performance)
to various life supporting measures during their nursing experience.
Part II:
It will consist of questions, which assess the knowledge of nurses on different
aspects of Life Support measures.
Part III
It will be an observation checklist with criteria to evaluate skills of nurses
regarding life supporting measures during resuscitation. The competence of
the nurses will be determined by observing their performance with Anne
Manikin.
3.9 Validity
Content validity of instrument and the educational package will be established
by seeking advises from review of literature and experts from Emergency
department, Department of Anesthesia and Medical-surgical Nursing
department. Necessary modifications will be done accordingly.
3.10 Pre-testing
Pre-testing will be done in 10% of the total required sample , those who were
included in the pre-testing will be excluded from the study.Necessary
modifications were done accordingly.
3.11 Ethical Considerations
Written permission will be obtained from College of Nursing and concerned
department before the data collection.
Informed (verbal) consent will be obtained from all the participants.
Confidentiality will be maintained.
3.12 Data Collection Plan
Phase I
Pre-test phase:
· Permission will be obtained from HOD Emergency , BPKIHS
· Data i.e. knowledge and skill regarding Life Support measures will be
collected with the help of self-administered, semi-structured questionnaire.
· Resuscitation skills will be measured using Anne Manikin. After completing

9. the questionnaire every participant will be requested to attempt resuscitation on
Manikin. Ability was assessed by observation on a checklist.
Phase II
Intervention phase:
· Circular will be sent to the concerned regarding the educational program by
taking formal approval from HOD Emergency, BPKIHS.
· For educational package, participants will be divided into groups based on
their availability and convenience, and the program will be conducted
accordingly.
· The total duration of educational programme will be one hour.
· Lecture combined discussion and demonstration method will be used.
· Power point will be used during lecture.
· Hands-out regarding the Various Life Support Measures will be provided to
each of the participants at the end of the session.
Phase III
Post-test phase:
· Post-test data will be collected after two week of educational intervention
from those respondents who participates in pre-test and intervention phase by
using the same research instrument in the pre-test.
3.13 Data Analysis Plan
· Data will be entered and analyzed on SPSS.
· Descriptive statistics i.e. percentage, mean, mode, median, interquartile range
and standard deviation will be used to report findings of pre-test and post-test.
· Inferential statistics i.e. McNemar Chi Square test, Wilcoxon Sign Rank test
and Spearman’s Rho Correlation coefficient will be used to find the
significance of difference between the variables.
· Analyzed data will be presented in tables and figures.
APPENDIX B: DATA COLLECTION PROFORMA
Please tick and provide answers as you feel appropriate. This will remain
confidential and will be used for the research purpose only.
Code no:
Ward:
Part- I: Socio-demographic information
1. Age of the participant………….. yrs
2. Level of Nursing course
a) Certificate Level
b) Bachelor level (B.Sc./ BN)
3. Your present position:
4. Your professional experience:

10. a) 0-3 yrs c) 7-10 yrs
b) 4-6 yrs d) more than 10 yrs
5. Have you ever had any in-service training on Basic and cardiac Life support
measures? Yes/ No
a) If yes, when did you take the course and its duration?
…………………………………………………………….
b) If no, do you want to have training on Basic and cardiac Life
support measures in this institution? Yes/ No
6. Have you ever witnessed a cardiac arrest during your nursing experience? Yes/ No
a) If yes, how many times? ……………..
7. Have you ever assisted in a BLS or ALS measures during your nursing
experience? Yes/ No
a) If yes, how many times? ……………..
8. Have you ever provided Basic Life Support during your nursing experience?
Yes/No
a) If yes, how many times? …………….
9. Have you ever provided Advanced Life Support during your nursing experience?
Yes/No
a) If yes, how many times? …………….
Part- II: Here are some statements. You are requested to tick the correct
answer.
1. a) Have you ever heard the word Cardiopulmonary Resuscitation (CPR)? Yes/No
b) If yes, what is it? ..................
2. a) Do you know the purposes of CPR? Yes/ No
b) If yes, what are they? .......................................
3. What are the conditions in which you should start CPR? ...............................
4. a) Have you ever heard the word Basic Life Support (BLS)? Yes/ No
b) If yes, what is it? …………………………………………………….
…………………………………………………...
5. a) Have you ever heard the word Advanced Life Support (ALS)? Yes/ No
b) If yes, what is it? …………………………………………………….
…………………………………………………...
6. ABCs of resuscitation or BLS refers to: A: …………
B: …………
C: …………
7. To assess the responsiveness of the victim, you would
a. Shout near the victim’s ear
b. Shake gently
c. Give a strong blow
d. Shake gently and call the name
8. The “ARREST TIME” refers to:
a) Time between the cardiac arrest and the institution of BLS

11. b) Time between the cardiac arrest and arrival to the hospital
c) Time interval of chest compression
d) Total time of resuscitation
9. How would you position victim prior to resuscitation?
a) In side-lying position on a flat surface
b) In semi-fowlers position on a soft flat surface
c) In prone position on a flat surface
d) In supine position on a firm flat surface
10. In the unresponsive victim with no cervical injury, airway is opened by
a) Head tilt and chin lift maneuver
b) Head tilt maneuver only
c) Jaw thrust maneuver only
d) By turning the head to the side
11. In case of cervical spine injury patient, airway is opened by
a) Head tilt and chin lift maneuver
b) Head tilt only
c) Jaw thrust maneuver only
d) By turning the head to the side
12. Breathing is assessed by
a) Observing the chest movement
b) Observing the chest movement and listening breath sound
c) Observing the chest movement, listening to breath sound and feeling air on
cheek
d) Feeling air on cheek
13. Assessment of breathing should be completed within
a) 5 sec c) 15 sec
b) 10 sec d) 20 sec
14. Once cardiac arrest is confirmed what is done immediately?
a) Defibrillation
b) Drugs
c) Chest compression followed by rescue breath
d) Rescue breath followed by chest compression
15. During chest compression, position of hands should be at the
a) Lower third of the sternum
b) Centre of the chest
c) Upper third of the sternum
d) Lower half of the chest
16. While performing chest compression, the nurse exert pressure by placing
a) The fleshy part of a clenched fist by side extending the finger over the
chest
b) The finger of one hand on the sternum and the finger of the other on top
of them

12. c) The heels of each hand side by side on lower sternum
d) The heels of the hand on the sternum and the heel of the other on top of it
interlocking the fingers
17. Depth of sternal compression for adult is
a) 1.5-2 inch c) 0.5-1 inch
b) 1-1.5 inch d) 2-2.5 inch
18. Sternal compression rate for adult is
a) 80-100/min c) 70-90/min
b) 60-80/min d) 60-90/min
19. During mouth to mouth ventilation, you should
a) Pinch the both nostrils with one hand and shield the victim’s mouth with the
lips
b) Shield the victim’s nose and mouth with your lips
c) Shield the victim’s mouth with your lips only
d) Shield the victim’s nose with your mouth
20. Chest compression to ventilation ratio is
a) 15:2 c) 5:1
b) 30:2 d) 30:1
21. Ventilation rate for adult is
a) 20-22/min c) 16-18/min
b) 10-12/min d) 15-20/min
22. What may be the commonest complication of chest compression?
a) Rib fractures c) Pneumothorax
b) Hemothorax d) Fat embolism
23. When should we stop giving Basic Life Support? ..................................
……………………..
24. Rearrange the following in the correct sequence.
a) Assess breathing
b) Check for safe environment
c) Start chest compression
d) Check for unconsciousness
e) Call for help
f) Give Rescue Breath
g) Clear Airway
25. The choice for VT/VF is
a. Manual Cardiopulmonary resuscitation
b. Immediate Defibrillation
c. Precordial Thumb
d. Use of Inotrops

13. 26. Best place to place the paddle of DF is
a. First paddle is placed on right side of chest just below the clavicle and second
on precordial region.
b. First paddle is placed on right side of chest just above the clavicle and second
on precordial region.
c. First paddle is placed on right side of chest just below the clavicle and second
on axillary line
d. First paddle is placed on right side of chest just below the clavicle and second
on left side below clavicle.
27. Paddle should be applied with the pressure equivalent to
a. 5 kg
b. 10 kg
c. 15 kg
d. 20 kg
28. Normal size of paddle for adult should be
a. 10 cm
b. 11 cm
c. 12 cm
d. 13 cm
29. Before pressing discharge botton call clear --- times
a) 2
b) 3
c) 4
d) 5
30. Most common drugs used during ALS are
a. Adernaline, atropine, Amidarone, lidocaine, sodabicarbinate, calcium
gluconate
b. Adernaline, atropine, Dpomaine and dobutamine
c. lidocaine, sodabicarbinate, calcium gluconate and broad spectrum antibiotics
d. lidocaine, sodabicarbinate, calcium gluconate
e. All emergency drugs

14. Part-III: Observation checklist
Nurses were observed skills regarding BLS in the Manikin in the following criteria
during their participation.
SCORES: Correct =3, Incorrect =2, Not performed =1
S.N Criteria 3 2 1
1.
2.
3.
4.
5.
6.
ASSESSMENT
a) Shake and shout to the victim to assess responsiveness.
AIRWAY
a) Open mouth and check airway.
CHEST COMPRESSION
a) Rescuers’ position:
i Appropriate height or kneel by the side of the victim.
ii Position of shoulder in relation to victim i.e.
vertically above with arms straight.
b) Correct hand position.
i. Location on the center of the chest.
ii. Place heel of one hand on top of other hand.
iii. Interlocking the fingers of hands.
c) Perform 30 chest compressions.
d) Release of chest compression.
Release all the pressure on the chest without losing
contact between hands and the sternum.
e) Rate of chest compression.
While compressing the chest, count the compression
as 1 and 2, and 3 and 4………… and so on.
RESCUE BREATHING
a) Head tilt.
b) Pinch the nostrils closed with thumb and index finger.
c) Open the mouth and maintain the mouth seal tight.
d) Give two slow (1 sec) breaths.
COMPRESSION TO BREATHING RATIO
30:2
CORRECT SEQUENCE
Assessment of the victim → Maintenance of the airway →
Chest compression → Rescue breath

15. ORGANIZATION OF THE STUDY: (TIME SCHEDULE)
SN Activities Duration/Time
1. Literature review and finalization of the project 2 Months
2. Pre-testing and finalization of tool 1 Months
3. Data collection and education intervention 6 Months
4. Analysis of Data 1 Months
5. Report writing and Submission 2 Months
……………………….
1 Year
Section-D
Details of the Budget:
SN Item/particular Amount (in RS.)
1. Preparation and printing of tools : 1700
2.preparation of information booklet :6000
3.data collection : 3000
4computer data entry and analysis : 3000
5. Report writing : 3000
6. Binding photocopy :2000
7.inservice education /training session : 5000
8. Others : 1300
Grand Total: 25,000

16. References.
1. Aitkenhead AR, Rowbotham DJ, Smith G. Textbook of Anesthesia. 4th edition. Churchill
Livingstone:2001
2. Barash PG, Cullen BF, Stoelting RK. Clinical Anesthesia.5th edition. Lippincott,
Williams and Wilkins: 2006
3. Handley AJ, Koster R et al. European Resuscitation Council Guidelines for Resuscitation
2005. Sec 2: Adult Basic Life Support and use of automated external defibrillators.
Resuscitation 2005; 67: S1, S7-S23.
4. Stoelting RK, Miller RD. Basics of Anesthesia. 4th edition. Churchill Livingstone: 2000.
5. Miller RS, Patton M, Graham RM, Hollins D. Outcomes of trauma patients who survive
prolonged lengths of stay in the intensive care unit. J Trauma. 2000; 48(2):229-34.
6. Rosenberg AL, Hofer TP, Hayward RA et al. Who bounces back? Physiologic and other
predictors of intensive care unit readmission. Crit Care Med. 2001; 29: 511–518.
7. Mehta NJ, Khan IA. Cardiology's 10 greatest discoveries of the 20th century. Texas
Heart Institute J. 2002; 29:164-71.
8. Julian DG. The history of coronary care units. British Heart J. 1987; 57:497–502.
9. Yaseen A, Venkatesh S, Samir H, Abdullah Al S, Salim Al M. A Prospective Study Of
Prolonged Stay In The Intensive Care Unit: Predictors And Impact On Resource
Utilization. International Journal For Quality In Health Care, 2002, 14:403-410
10. Rosenberg AL, Hofer TP, Hayward RA et al. Who bounces back? Physiologic and other
predictors of intensive care unit readmission. Crit Care Med. 2001; 29: 511–518.
11. Weissman C. Analyzing intensive care unit length of stay data: problems and possible
solutions. Crit Care Med. 1997; 25: 1594–1600.
12. Praveen K, Devajit S, Reeta S et al. Demographic Profile and outcome analysis of a
tertiary level pediatric intensive care unit. 2004; 71(7): 587-591.
13. Kanus WA, Draper EA, Wagner DP et al. Compression of Frequency distribution in
demonstration unit and 13 tertiary hospitals. Crit Care Med. 1985; 13: 823.
14. Azoulay E, Pochard F, Chevret S, Lemaire F, Mokhtari M, Fall JL et al. Meeting the
needs of intensive care unit patient families: A multicenter study. Am. J. Respir. Crit.
Care Med. 2002; 163: 135-139.
15. Espinosa L, Young A, Symes L, Haile B, Wsalsh T. ICU Nurses’ experiences in
providing terminal care. Critical Care Nurse. 2010; 33(3): 273-28.
16. Molter NC. Needs of relatives of critically ill patients. Heart Lung. 1979; 8: 332-339.
17. Hardcer J. Meeting the needs of families of patients in intensive care units. Nurse Times.
2003; 99(27): 26-7.