A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science in Nursing Johannesburg, 2015 / Background: Despite the empirical evidence of the significance of weaning protocols in Intensive Care Units, variations still exist in the adoption of weaning protocols. Multidisciplinary teams hold the responsibility for the introduction and development of weaning protocols in PICU. Purpose: To explore and describe the opinions of multidisciplinary teams practicing in the paediatric and cardiothoracic ICU at an academic hospital in Johannesburg concerning weaning protocols from mechanical ventilation. Design: Qualitative descriptive. Method: Data was collected from multidisciplinary team comprising of registered nurses (n=8) and doctors (n=2) practicing in PICU and CTICU who were purposively selected using semi-structured interviews to obtain qualitative information on their opinions regarding weaning protocols. Data collected was analysed using a Braun and Clarke method of qualitative thematic analysis. Seven categories were identified in which three themes, which provided the fundamental structure of the findings for the discussion, emerged and included the following:  Unstructured weaning – the current practice.  Recognition of the need for weaning protocols.  Being not in favour of weaning. Results: The majority of the multidisciplinary team members recognise the need to develop weaning protocols in PICU for standardisation of practice. Currently there are no weaning protocols and a multidisciplinary approach was identified as an important strategy to develop the protocols. However, nurses practicing in PICU are not trained in Critical Care nursing which poses a challenge to the practice. Conclusion This study indicates that there is need for the development of weaning protocols in PICU. Although nurses are weaning patients in PICU, there are no standardised weaning protocols to guide the practice. The study therefore suggests the need to develop weaning protocols through multidisciplinary approach and training of nurses in critical care nursing to improve knowledge base and skills. Keywords: Mechanical ventilation, weaning, protocols, paediatric patients, opinions/perception and multidisciplinary team.

No description available.

Thesis (M.P.H.)--University of Hong Kong, 2008. / Includes bibliographical references (p. 41-43).

Thesis (M.H.A.)--University of Michigan, 1957.

Thesis (M.H.A.)--University of Michigan, 1957.

Thesis (M.S.)--University of Michigan, 1990.

Thesis (M.S.)--University of Michigan, 1990.

The research objective was: to determine (a) the extent of the present involvement of neonatal intensive care nurses in technology assessment, (b) their perceptions of the technologies with which they worked, and (c) their perceptions of requirements for improvements in the technology assessment process. Nurses and senior staff (nursing s.u perv.i sors, NICU consultants and training officers) ln the neonatal intensive care units (NICUs) of five hospitals in London were included in the study sample. They completed questions regarding new medical technologies in general and NICU technologies in particular. Nurses and senior does not prepare Further, in some training regarding staff believed that nurses' training them adequately for new technologies. instances, nurses had not received a new technology prior to using it. Neither nurses nor senior staff were fully aware of formal processes for technology assessment in their hospitals, but did identify informal processes. While a small minority of the nurses had been directly involved in decisions regarding the new technologies, more than half had made recommendations. The nurses considered their level of involvement unsatisfactory, and believed (as did the senior staff) that their hospital could improve its procedures for purchasing, introducing and using new technologies. Most of the nurses who were planning to remain in neonatal intensive care were dissatisfied with their involvement and with their hospital's methods for adopting new technologies. One-third of the nurses and most of the senior staff identified examples of nurses' having contributed to the development and adaptation of new equipment and procedures, either formally or informally. The impacts considered most significant by nurse participants were: job stress, increased ethical, legal or social concerns, and decreased reliance on clinical judgment or skills of nurses.

published_or_final_version / Community Medicine / Master / Master of Public Health

This thesis focuses on the explanation of anomalies as an approach to anomaly-driven revision of a theory. An anomaly is identified when a theory (or model of a domain) does not accurately reflect a domain observation, indicating that the theory (or model) requires refinement. In some cases an explanation can be generated for an anomalous observation using existing domain knowledge and hence a revision to the existing theory can be provided. Ontologies have been used in both stages of an investigation presented in this thesis; in the first stage, a domain ontology and expert-acquired strategies have been used as part of a knowledge-based system, EIRA (Explaining, Inferencing, and Reasoning about Anomalies), to generate explanations for an anomaly; in the second stage, domain ontologies have been used to suggest refinements to an incorrect or incomplete domain ontology. In the first stage of the investigation, extensive interviews were held with domain experts; the analysis of which led to the identification of both examples of anomalies encountered in the domain and the strategies used by the domain experts to provide (appropriate) explanations for the anomalies. EIRA is able to replicate these explanations; when EIRA is presented with an anomaly, potential explanations are generated by the application of expert-acquired strategies to the domain knowledge, patient data, and information about the clinical situation. To evaluate this approach, EIRA has been applied in the Intensive Care Unit (ICU) domain and ICU clinicians have evaluated the explanations produced by EIRA. The strategies used by EIRA have been abstracted further to form generic strategies for anomaly resolution. In the second stage, EIRA has been extended to investigate the use of domain ontologies to suggest refinements to an incomplete or incorrect ontology. These additional refinements are generated by reasoning about analogous concepts from the domain ontology. The findings described in this thesis support the belief that ontologies can be used to generate explanations to refine a theory, further, that the extensive domain knowledge contained in an ontology allows for sophisticated refinements of a knowledge base. Previous approaches to theory revision have largely focused on the refinement of an instantiated rule base, in which limited domain knowledge is incorporated in the rules and hence the refinements are essentially captured in a particular knowledge base. In these earlier approaches, refinements to remove the anomaly were generally suggested after applying machine learning techniques on data from the domain; however, this process requires large datasets, the refinements generated are not always acceptable to domain experts, and providing explanations (using an ontology) to account for anomalies have not been investigated. I believe that the findings reported in this thesis are significant and make a number of contributions including a novel approach to anomaly-driven revision of a theory.