| Background Patients with impaired or compromised eye protective mechanisms in an ICU are at high risk for developing eye complications for the reasons of the disorders and treatments which they need. They are potentially vulnerable to ocular surface diseases which at worst can lead to permanent visual impairments or visual loss. The bad outcomes obviously affect the patients' life qualities. Related studies are few abroad. There are several researches explored the best eye care interventions for critically ill patients, while there is only one similar research on this topic in mainland China which cannot supply effective evidence adequately . Due to insufficient reliable evidence based nursing care interventions and lack of regular nursing standard in this area, a study design was developed based on a nurse survey of eye care practices in the intensive care units and eye care knowledge for critically ill patient combined with the information from literature review. To improve the evidence based nursing practices in clinical setting and provide more information to make scientific, effective, practical and convenient nursing standard and nurse educational programme, a randomized controlled study among three groups (intervention group 1, intervention group 2 and control group)was undertaken to explore nursing care interventions which can effectively reduce the eye complications in critically ill patients.Objectives To describe ICU nurses' practices and knowledge of eye care for critically ill patients. To compare and evaluate the effectiveness of two patterns of eye care interventions on coma patients hospitalized in the intensive care units.Methods The study is composed of two phases. phasel: A nurse survey was conducted in the intensive care units to investigate eye care performances. It was also undertaken to find out nurses' knowledge of eye care for critically ill patients and the influence factors of understanding it. 145 nurses who were working in the intensive care units of three university hospitals (convenience sampling) were enrolled. They were assessed by the Eye Care Practices for Critically Ill Patient Scale and the Eye Care Knowledge for Critically Ill Patient Scale. Phase2: 149 critically ill patients who met the inclusion criteria were recruited consecutively in three intensive care units of a university hospital and were randomised to any of the three groups using a random number table. Excepting the lost cases, 119 subjects completed the study. Of these patients, 39 were assigned to intervention group 1, while the other two 40 were distributed to intervention group 2 and control group respectively. There were no statistically significant difference in potentially confounding variables among three groups, such as age, gender, duration of hospitalized in an ICU, diagnosis, length of coma, score of Glasgow Coma Scale, airway intubation, the amount of time patients received sedatives or muscle relaxants, nutritional support way and gross resting position of the eyelids (P>0. 05) . Patients who were in intervention group 1 received five days' nursing interventions including eyelid cleasing, polyethylene film covering, irrigation of the eye, observation and documentation, while intervention group 2 patients received five days' nursing intervention including eyelid cleasing, ofloxacin eye gel dropping, observation and documentation. The control group patients received routine care(Lincomycin Hydrochloride eyedrop used during day time and chlortetracycline ointment used in night for lagophthalmos patients only) of the clinical setting for five days as well. Corneal epithelial abrasions was used as the outcome measurement to evaluate the efficacy of the eye care patterns at 72hr and 120hr after the beginning of interventions.ResultsThe results of phase 1:①nurses' practices of eye care for critically ill patients: Most of the nurses stated that there were eye care methods for comatose, lagophthalmos or mechanically ventilated patients in the intensive care units. For lagophthalmos patients, using ophthalmic preparations was the most common method. The findings of the investigation suggest that most of the nurses performed eye care approaches such as eye assessment, eye hygiene regimes and prevention of dry eyes for critically ill patients in related settings. Antibiotic ophthalmic preparations were commonly utilized to keep the eye surface wetting.②nurses' knowledge of eye care for critically ill patients: The mean score was 19.88±1.19 (65.66 in 100) . All of them knew that unconscious patients were at risk for developing eye complications. 105(72.4%) realized that regular assessment of the lid position was one of the cornerstones of eye care in the critically ill. 123(84. 4%) thought keeping ocular surface moisture was the vital method to prevent eye complications. However, just 2(1.4%) of them knew how to discern the signs of ocular surface infection. Only 37(25. 5%) of them considered that the incidence of eye disorders might be partly attributed to the tight secure tape used to keep the airway intubation in place. The length of working time in an ICU was the influence factor of the nurses' understanding of eye care knowledge.The results of phase 2: Analysis by Generalized Linear Mixed Effects Models (PROC GLIMMIX process of SAS 9.13) presented as follows. The differences in corneal epithelial abrasion among the treatment and control groups between two examinations were of statistical significance (P<0. 05). In the comparison of pair match, the differences in corneal epithelial abrasion between the two groups at 72hr were all statistically insignificant (P>0. 05) , while those at 120hr were all statistically significant (the diferences between intervention group 1 and control group, P<0. 001; the diferences between intervention group 2 and control group, P<0. 01; the difference between two contrl groups, P<0.05). In the treatment groups, the differences between examinations at 72hr and 120hr were of statistical insignificance (P>0. 05)in corneal epithelial abrasion, while in the control group, the difference was statistically significant (P<0. 001) .Conclusion Currently, it is yet to form a uniform nursing standard based on effective evidences for critically ill patient. It still needs to improve ICU nurses' commanding of knowledge on eye care. Two patterns of eye care interventions resulting from the relevant literature review and the investigation of eye care practices combination can effectively reduce the occurance of corneal epithelial demage in critically ill patients and reserve potential cost-effectiveness as well. The study can serve as a reference for making standards and guidelines for nursing practices in relevant departments. It also helps in developing nurse educational programmes for critically ill patients.
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