الفهرس 
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Abstract
Critically ill patients are patient who have sustained or at risk of sustaining single or multiple organ dysfunction. Thus, critically ill patients have particular predisposing factors for developing eye problems and complications either due to their general conditions and or clinical characteristics. Eye care is a fundamental nursing procedure essential for all critically ill patients from admission to the ICU until discharge. It should be a priority even if patients’ survival is not sure.
The current study was conducted to evaluate the effect of the closed eye care method on outcome indicators in critically ill patients. The study hypotheses propose that, patients receiving eye care using the closed eye care method have fewer problems than patients receiving the routine eye care. Patients receiving eye care using the closed eye care method have lesser complications than patients receiving the routine eye care. Patients receiving eye care using closed eye care method have eye moisture more than that in patients receiving routine eye care.
To fulfill the aim of the study; a quasi-experimental research design specifically, time series nonequivalent control group design was used to conduct the current study. This study was conducted in the General ICUs (Unit III and I) and the specialized ICU (Neurosurgical ICU) of Alexandria Main University Hospital, University of Alexandria.
A convenient sample of 50 adult patients ”100 eyes” were recruited from the previously mentioned ICUs. Patients were of either sex, their age ranged from 18 to 60 years. The GCS of the included patients was ≤ 8 and the blinking reflex was absent. The included patients had an orally inserted ETT and were mechanically ventilated. Patients who were receiving sedatives for 2days or more were also included in the study. The total sample was divided into two groups; the CEC and the REC group. Each group included 25 patients ”50 eyes”. The studied groups were matched according to patients’ age, medical diagnosis, LOC, PEEP value, hydration status, and the presence of sedatives. Only one tool was used to collect data.
The results of the current study reveal that, no significant differences were noted between the studied groups regarding the initial ophthalmologic details” specific eye assessment data” specifically data related to eyelid problems, eye opening score, eye discharge, conjunctival edema, eye moisture, corneal integrity and opacity
The findings of the current study reveal that, the studied groups had significant differences on three of the study variables only. The first variable was related to the general assessment data specifically the presence of copious secretions. A larger number of the CEC patients had copious secretions. This means that the CEC patients had a more serious condition. The other two variables were related to the ophthalmologic details clustered from the specific eye assessment data indicating conjunctival injection and corneal exposure. A larger number of the REC eyes had conjunctival injection but this variable did not have any serious bearing on the condition of the eyes. A larger number of the CEC eyes had corneal exposure; this means that CEC eyes had a more serious condition.
The current study findings reveal that the most prevalent eye problems or complications among the entire sample of the study at the final measurement obtained were eye dryness, incomplete eyelid closure, and conjunctival injection respectively.
Regarding the other observed eyelid problems at the final measurements obtained from the studied groups, findings of the current study reveal that, only two of the CEC had pressure marks; an additional two CEC eyes had pressure areas over the nasal bridge. Likewise, only two of the REC had an eyelid skin laceration. Only one of CEC eyes had an eye discharge at the final measurement obtained. More than three quarters of the REC eyes had an eye discharge at the final measurement in comparison to the initial measurement obtained; a larger number of the REC eyes had an eye discharge in comparison to the CEC eyes at the final measurement in obtained. The differences between the final measurements obtained from the studied eyes were significant. These findings support the study hypothesis which proposes that, patients receiving eye care using closed eye care method have fewer problems than patients receiving the routine eye care
The findings of the current study reveal that, a larger number of the CEC and the REC eyes had a corneal exposure at the final measurement in comparison to the initial measurement obtained. The differences between the initial and the final measurements obtained from the studied eyes concerning the eyelid position were significant. This indicates that there was a tendency toward the increase in the final corneal exposure in comparison to the initial eyelid position. There was a trend toward increase in the final corneal exposure of the CEC eyes in relation to initial eyelid position.
The findings of the current study reveal that, a larger number of the REC eyes had severe eye dryness at the final measurement obtained in comparison to that of the CEC eyes; it was four times of that of the CEC eyes. The difference between the CEC and the REC eyes at final measurement obtained regarding the eye moisture was significant. This finding support the study hypothesis which proposes that, patients receiving eye care using closed eye care method have higher eye moisture than that in patients receiving routine eye care.
Eyes which had an impaired corneal integrity in the final measurement obtained were from the REC eyes only. The difference between the CEC and the REC eyes at the final measurement obtained regarding the incidence of impaired corneal integrity was significant. This finding support the study hypothesis which proposes that, patients receiving eye care using closed eye care method have lesser complications than patients receiving routine eye care.
It can be concluded from this study that, critically ill patients’ eyes are exposed to a wide array of problems and complications. These include eye dryness, incomplete eyelid closure conjunctival injection, conjunctival edema, eyelid edema, eye discharge, and impaired corneal integrity. The most commonly evident eye problem is the eye dryness. It may lead to impaired corneal integrity which may end with permanent visual impairment.
Eye care using the closed method is more effective than the routine eye care where, patients receiving closed eye care have fewer problems such as eye discharge which indicates an eye infection, lesser complications such as impaired corneal integrity, and lesser incidence of eye dryness than that in patients receiving the routine eye care. Health care providers must receive training before implementing the closed eye care using the swimming goggles to prevent and avoid problems such as local pressure areas which most commonly results from tight application of the goggles.
The most important recommendations from this study are as follows, the ophthalmologic problems and complications in quality of care performance indicators in ICU because critically ill patients are exposed to a wide array eye problems and complications. Assessment of the eye and risk factors for eye problems and complications must be implemented at a regular basis. Abnormal eye assessment cues must be reported to the responsible ICU physician. Patients’ eyes must be kept closed and covered so as to prevent eye dryness Health care providers in ICU must receive training before implementing the closed eye care using the swimming goggles to prevent and avoid problems such as local pressure areas which most commonly results from tight application of the goggles.