Thesis (M.Nurs.)--University of Hong Kong, 2008. / Includes bibliographical references (p. 142-150)

Thesis (Ed.D.)--Teachers College, Columbia University. / Typescript; issued also on microfilm. Sponsor: Marie Seedor. Dissertation Committee: Nathan Lefkowitz. Includes bibliographical references.

Background: Critically ill abdominal surgery patients are at risk of developing a paralytic ileus. Multidisciplinary interventions aim to prevent post-operative complications in the intensive care unit; including interventions to prevent the development of a paralytic ileus. However, the implementation of preventative interventions occurs ad hoc and these high risk patients still develop a post-operative paralytic ileus. Aim: The aim of the study was to explore the implementation of post-operative interventions used in the critical care unit to prevent a paralytic ileus in patients following major open abdominal surgery. Research design and methods: A quantitative, exploratory retrospective research design was used to answer the research question. Patient medical records were retrieved from a specialised intensive care unit situated in a private hospital in Gauteng. A unit of analysis represented the study population and a sample frame was used for choosing patient medical files in the study. Data was collected using a data collection sheet developed from literature. Data was analysed using descriptive statistics (frequency tables, odds ratio, relative risks, Pearson Chi-square test and Fisher’s exact test). Results and Conclusions: After data analysis, the results of the study were documented. Conclusions deducted from this study highlighted three significant interventions associated with the incidence of a post-operative paralytic ileus. Further research on these three interventions may possibly prevent a paralytic ileus in critically ill abdominal surgery patients in the future. Implementation of specific evidence-based post-operative interventions has been recommended to critical care providers of the private hospital group. / Dissertation (MCur)--University of Pretoria, 2020. / Nursing Science / MCur (Nursing Sciences) / Unrestricted

Background: Acute kidney injury occurs in one out of ten cardiac surgery patients. Cardiac surgery-associated acute kidney injury not only increases patients’ mortality rate but the length of stay in intensive care unit and hospital. Cardiac surgery patients’ long- term risk for chronic kidney disease and heart failure increases with the incidence of acute kidney injury. Various preoperative, intraoperative and postoperative risk factors are associated with the development of cardiac surgery-associated acute kidney injury. Aim: The aim of the study was to identify the risk factors associated with acute kidney injury in patients who underwent cardiac surgery. The identified risk factors were categorized into modifiable, partially modifiable and non-modifiable risks. The frequency of acute kidney injury among cardiac surgery patients was also assessed. Research design: The researcher chose a quantitative correlational retrospective design and conducted a retrospective chart review to assess the risk factors associated with AKI in patients that had undergone cardiac surgery. Methods: Non-probability purposive sampling was used to select the records of patients that underwent cardiac surgery between January 2014 and December 2018. Data collection was done using a self-developed audit tool. Descriptive and inferential statistics were used for data analysis. Significance: The study enabled the researcher to identify and categorize the risk factors into modifiable, partially modifiable and non-modifiable categories. Early recognition and mitigation of risk factors could prevent patients from developing cardiac surgery- associated acute kidney injury. Research findings: The study found a 22.7% frequency of CSA-AKI. Anaemia, hypoalbuminemia, hyperglycaemia, use of N-acetylcysteine and fluid overload were identified as modifiable risk factors. Bicarbonate level <22mmol/L, use of diuretics, use of antibiotics, longer duration of surgery, fresh frozen plasma use >500ml on the day of surgery, red blood cell transfusion >1L on the day of surgery and prolonged use of mechanical ventilation were partially modifiable risk factors. No non-modifiable risk factors were identified. Keywords: Cardiac surgery-associated acute kidney injury; risk factors; modifiable, partially modifiable and non-modifiable. / Dissertation (MCur (Critical Care Nursing))--University of Pretoria, 2020. / Nursing Science / MCur (Critical Care Nursing) / Unrestricted

Poor communication is identified as the root cause for the majority of sentinel events in hospitals, including wrong site surgery, medication errors, and failure to rescue. Interdisciplinary rounding (IDR), a long-standing practice in the Intensive Care Unit (ICU), provides a forum for communication and collaboration and has been linked to improved patient outcomes. Most of the research regarding IDR has been performed in the ICU setting within academic medical centers. IDR outside of the ICU has demonstrated similar clinical outcomes but a gap exists in the literature regarding the impact of IDR participation on the nurse, particularly for nurses working in the non-ICU setting within community hospitals. This led to the development of a research question. Basic Psychological Needs Theory was chosen as the theoretical framework – to specifically assess how participation in IDR affected the nurses' sense of autonomy, competence, and relatedness. A mixed method study was conducted in a community hospital in Central Florida using surveys and semi-structured interviews. Results indicated ICU nurses perceived a higher level of collaboration with physicians than nurses working outside of the ICU but this did not correlate with satisfaction of the ICU nurses' basic psychological needs. Only the nurses' level of experience and advanced nursing education appeared to have any significant impact on satisfaction of the nurses' basic psychological needs. The interview responses confirmed the presence of different rounding processes and levels of collaboration outside of the ICU, which helped to explain and support study outcomes. Opportunities for process improvements were also identified.

Healthcare systems have been demonstrably altered because of the COVID-19 pandemic. Resources were stretched and patient conditions deteriorated on a scale previously unseen, leaving nurses at the forefront to face the adversities brought about by the pandemic. In this study, a questionnaire was utilized to better understand how COVID-19 has impacted the stress level, resilience/well-being, moral distress, job satisfaction/enjoyment, practice environment, and intent to remain in the nursing profession of nursing alums from East Tennessee State University. This study focused on a subset of nurses working in critical care, to consider the impact that the pandemic had on ICU nurses’ emotional well-being and job enjoyment. This study collected general demographics and information regarding how each participant’s work was impacted as a result of COVID-19. The Practice Environment Scale of the Nursing Work Index (PES-NWI) questionnaire, Job Enjoyment Scale (JES), and Professional Quality of Life (Pro-QOL) scales were also leveraged to gain an understanding of the participants’ perspectives on their work and mental situations. The results showed that critical nurses generally answered more negatively on the PES-NWI, JES, and ProQOL scales. The study concludes that ICU nurses have lower emotional well-being and job enjoyment than nurses in general and may have been more greatly impacted by the COVID-19 pandemic.

Thesis (Ph. D.)--University of Missouri--Columbia, 2003. / "May 2003." Typescript. Vita. Includes bibliographical references (leaves 24-27, 70-73).

Introduction Patient safety IS fundamental to quality health and nursmg care and the ongomg improvement of patient safety is one of the most urgent issues facing health care today. Quality health and nursing care is a process which can be monitored, but which requires ongoing evaluation and change. The poor quality of patient care is a major problem of many hospitals in Rwanda and the University Central Hospital of Kigali, (CHUK), is no exception, especially in the Intensive Care Unit, (ICU). (Rwanda Ministry of Health Report, 2005). Pmpose of study The purpose of this study was to describe and explore the structure and processes of quality patient care at CHUK Intensive Care Unit, using the JFICM minimum standards, in order to improve the current quality of patient care and to further highlight gaps that might exist in this care for further research. Methodology The research was conducted in the Intensive Care Unit at CHUK. A checklist and self-reporting questionnaires, which were developed by the researcher, guided by the Joint Faculty ofIntensive Care Medicine (2003), constituted the instrument for this study. The sample consisted of 41 participants who were health care workers in the ICU and 20 of the patient's files. These files were used for researcher's observations during the period of data collection being 20thJune to 20th July 2008. A descriptive quantitative design was used. Results Design: While the ICU was in a self contained area with easy access to other departments the actual work environment did not comply with the recommendations of the JFICM (2003) minimum standards ofICU. ICU staffing: The staff consisted of only 1 medical doctor consultant and three specialist anesthetists. There were 11 Registered nurses (RNs) and 16 Enrolled nurses (ENs). A physiotherapist and dietician were available, but there was no biomedical engineer. The quantity of equipment was not adequate for the workload in the unit. There were no guidelines or protocols for nursing care and the unit had neither in-service training programmes nor research programmes available to the medical and nursing staff. While vital signs, ECG and oxygen were well monitored by using the nursing file (Appendix 10), the monitoring of patients was done without any guidelines or written procedures. The nursing reports, also, did not follow any guideline or procedure. Communications were generally poor because of the lack of equipment. The phone was not working for most of the time and there was no biotechnical engineer available to monitor the material and equipment. Conclusion According to the analysis of the structure and process standard based on JFICM (2003), the minimum standard of quality of ICU patient care at CHUK needs to be improved because the unit does not comply with an appropriate design, fulfil the staffing and operational requirements, or have the necessary equipment. Due to the shortage of qualified staff, plus the unavailability of protocols or guidelines, the processes of quality patient care were inadequate and need to be improved. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2009.

Aim: The aim of this study was to explore perceptions and practices of ICD nurses, when supporting families of critically ill patients, in two hospitals in Blantyre, Malawi. Methodology: A descriptive qualitative approach was used to explore perceptions and practices of ICD nurses, when supporting families of critically ill patients. Simpson's Conceptual Framework was used to guide this study. Purposive sampling was done where five nurses from a public and five from a private hospital were interviewed until data saturation. Repeat interviews were conducted at two week intervals, for data depth and verification. Each interview lasted 25-40 minutes. All interviews were tape recorded and transcribed. Manual data analysis was used to identify themes and categories. Documents used for family support care were also reviewed. Findings: The study revealed that nurses acknowledged that families experienced stress due to critical illness and ICD admission of their loved ones. The study also reiterated that families have psychological, social and spiritual needs, including the need for information, comfort and proximity to their loved ones. Nurses met the families' needs through empathy, dedication and commitment, inclusion of families in patient care and decision making and information giving to promote understanding and endurance during the stressful period. ICD nurses encountered some challenges when they provided support care to families, which included families' interference from wanting to be with their loved ones all the time, lack of clear policies to guide family support care, limited time to attend to the relatives due to shortage of nurses and nurses' own stress, especially when they did not have enough information to answer questions from families, when communication was inadequate from physicians to families. In addition all participants did not have formal training except "on the job" orientation, which was not enough to prepare them for family support care. Recommendations: Recommendations have been suggested for improvements m nursing practice, nursing management, nursing education and future nursing research. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009.

The aim of this study was to describe and compare the needs of families of critically ill patients in two adult ICUs from both the family and the nurses' perspectives. A non-experimental descriptive survey design with a quantitative approach was used to explore the family members' needs in an ICU situation. For this study, a non-probability convenience sample of 50 critical care nurses and 50 family members from adult Intensive Care Units (ICUs) in two tertiary hospitals was used. The Critical Care Family Need Inventory (CCFNI) (Molter, 1979) was used as a data collection instrument. There were different perceptions of family needs between families and nurses. Nurses were accurate with 21 (47%) of the 45 families' need items which was less than half of their perceived family needs compared to family members' perceptions despite the fact that the two groups were in agreement with 5 of the first 10 most important needs. Recommendations for future practice included incorporation of educational programmes for critical care nurses concerning family needs in ICU settings, and the provision of specific in-service training to improve communication skills. Critical care unit, critical care nurse, critically ill patient, family, family member, needs, perception, critical care nursing. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2010.