"Objective: The purpose of this Doctoral of Nursing Practice (DNP) project was to conduct a survey to evaluate nurses’ knowledge, perceptions, attitudes, and beliefs regarding sleep promotion in the ICU. Background: Critically ill patients admitted into the Intensive Care Unit (ICU) are introduced into unfamiliar environments with numerous interruptions that interfere with proper sleep. Sleep deprivation among critically ill patients can have detrimental consequences for the patient and organization. Competing nursing priorities, lack of knowledge, opposing perceptions, and lack of resources prevent the implementation of strategies to promote patient sleep. Methods: This project used a descriptive design to conduct the assessment. A web-based survey was distributed to assess nurses’ knowledge, beliefs, attitudes and perceptions regarding sleep promotion in the ICU to help identify areas for improvement and barriers to implement an effective quality improvement plan. Setting: A 30-bed ICU at an academic medical center with 268 licensed beds in Phoenix, AZ with medical-surgical, cardiac, neurological, vascular, and transplant patient populations. Participants: Sample of 57 out of 175 critical care nurses who work in this project’s ICU setting. Findings: ICU nurses demonstrated concern for lack of sleep among critically ill patients, but it is difficult to promote due to competing priorities and tasks. Nurses overall understood the negative effects of sleep disruption among critically ill patients, but discussed the importance of maintaining staff accountability, working collaboratively with the interdisciplinary team, promoting consistency in care, and obtaining support and resources from administration to implement effective interventions. Implementation: Identified barriers and gaps should be utilized to direct quality improvement efforts that help promote uninterrupted sleep among critically ill patients."

Organisational change in any organisation, including the healthcare industry, implies a change in organisational culture. The concept of organisational culture refers to those values and norms within an organisation that are prescribed by both the employer and the employees as to how to behave. However, organisational culture should not be viewed in isolation, as culture and leadership are intertwined. Transformational leadership within an organisational culture serves to achieve its goal, missions and aims by influencing, motivating and creating a mutual relationship between employees and employers, which brings about effective organisational change. The alignment of organisational culture and leadership with a hospital’s vision is important to ensure optimal healthcare delivery and organisational change outcomes. A positivistic research paradigm, with a quantitative, explorative, descriptive and contextual approach, was used to conduct the research study. The research study explored whether a supportive organisational culture, transformational leadership and organisational change outcomes were prevalent in public intensive care units. Secondly, the study aimed to investigate the relationship between organisational culture, transformational leadership and organisational change outcomes in public intensive care units in the Nelson Mandela Bay. Data was collected by means of a structured and previously validated questionnaire with a Cronbach’s alpha of more than 0.80. The target population was registered nurses who work in the intensive care units in the public hospitals. The sample was composed of 56 registered nurses and 4 enrolled nurses who were selected from public hospital intensive care units in Nelson Mandela Bay. Descriptive statistics, linear regression analysis, correlation and a Chi-square test were used to describe the hypothesised relationship between organisational culture and transformational leadership (independent) with organisational change outcomes (dependent variable). The results of this study revealed that the alternative hypothesis was accepted as the P value, was less than 0.05 in all variables. This proved that there was a significant relationship between organisational culture, transformational leadership and organisational change outcomes in the public intensive care units which were sampled. Recommendations are made as to how organisational culture can enhance and support transformational leadership and organisational change outcomes to promote a positive change outcome in public intensive care units. Ethical considerations were maintained throughout the research study.

Abstract Systematic analyses of infections in critical illness are sparse and mostly restricted to specific infection categories. Thus, a prospective study was carried out in a medical-surgical ICU during 14 months on patients whose ICU stay was longer than 48 h. The prospectively gathered data included detailed patient history, infection survey, severity of illness scores (APACHE II, SOFA), resource use, short-term and long-term outcome and quality of life following hospital discharge. Altogether 335 patients were included, of whom 251 (74.9%) had an infection on admission; 59.3% had a community-acquired infection (CAI) and 40.7% a hospital-acquired infection (HAI), while 84 (25.1%) did not have any infection (NI). APACHE II scores and ICU or hospital mortality rates did not differ between the groups. The median hospital stay was longer in the HAI than in the CAI or NI groups. Eighty (23.9%) of the 335 patients developed an ICU-acquired infection (48 per 1000 patient days): ventilator-associated pneumonia (VAP) in 33.8% of the cases, central catheter-related (CRI) or primary bloodstream infections in 6.3% and urinary tract infections in 1.3%, while the corresponding device-related incidences per 1000 days were 18.8, 2.2 and 0.5, respectively. ICU-acquired infection was an independent risk factor for hospital mortality. It doubled the risk for hospital mortality in patients with an infection on admission and caused a threefold the risk in patients without an infection on admission and an almost fourfold increase in the use of nursing resources. Of the 272 hospital survivors, 83 (30.5%) died after discharge during the median follow-up of 17 weeks. Infection status on admission or during the ICU stay did not affect long-term mortality. ICU-acquired infection did not have an impact on patients' quality of life. The current general level of health compared to the status before ICU admission did not differ between the groups, either. Only 36% of those employed resumed their previous jobs. Three-fourths of patients had an infection on admission, while nearly one fourth acquired an ICU infection. The high VAP rate suggests a need for re-evaluation of preventive measures, whereas the low CRI indicates more successful prevention. ICU-acquired infection was a significant risk factor for hospital mortality, but did not affect patients' long-term survival or quality of life.

D.Cur. / The overall objective of this research study was to develop a model of emotional intelligence for the facilitation of wholeness in critical care nurses in South Africa. Critical care nurses often nurse three or more critically ill patients during one shift (Fiakus, 1998). The environment in the critical care unit is highly stressful, highly emotionally charged and emotionally demanding for the nurses that work there. This can lead to the nurse developing burnout (Coates, 2001 ). Burnout in a critical care nurse can have devastating consequences such as decreased well-being of the nurse, decreased quality of care, poor communication and increased costs to the employer related to absenteeism and high staff turnover (Poncet, Toullic, Papazian, Kentish-Barnes, Timsit, Pochard, Chevret, Schlemmer & Azoulay, 2006). In a study by Shipley, Jackson and Segrest (2004), it was found that staff with increased emotional intelligence enjoyed better emotional health and more satisfaction both at home and at work. The question that arose was what is the emotional intelligence of critical care nurses in South Africa. A theory-generative, exploratory, descriptive and contextual research design was used. The research study was carried out using a modification of the method of theory generation as described by Chinn and Kramer (1985). Step one dealt with the empirical phase in which the main concept was distilled from the results of the data analysis. The quantitative research design used for this phase was a typical descriptive survey design. The entire accessible population (N=380) consisted of registered nurses that attended the Critical Care Congress in 2009. They represented a wide range of registered nurses that worked or had worked in critical care in both the private and public health sectors in South Africa. The data collection instrument consisted of a biographical datasheet from which the sample (n=220) was divided into various context groups. Participation was voluntary and all participants signed a consent form. The second part of the data collection instrument consisted of the Trait Emotional Intelligence short form (TEIQue-SF). The data was analysed using SPSS. The sample consisted mainly of a group of mature, female and professionally experienced critical care nurses. They held a variety of job descriptions in critical care nursing. Nurses who are older and have more experience in critical care appear to have a higher range of emotional intelligence. This was also confirmed in a study by Shipley et al. (2004) in which emotional intelligence was associated with work experience. Based on the tests of normality, there was no significant difference in the emotional intelligence of the various context groups that were identified from the single sample (n=220). The exploratory factor analysis identified eight factors as having eigenvalues greater than 1. The statistical evidence pointed to concentrating on factors 1 and 2, and pragmatically these two factors became the focus of the model, as they form the central essence of emotional intelligence of the critical care nurse. The facilitation of inherent affective and mental resourcefulness and resilience was the main concept of the model. Step two comprised the definition and classification of the central and related concepts. This was achieved by finding dictionary meanings and their subject usage. The attributes identified were synthesised to form a definition in chapter five. Step three provided a description of the model. A visual application of the model was shown in chapter six, which highlighted the concepts as proposed by Dickoff, James and Wiedenbach (1968). Three stages of the process of facilitation of emotional intelligence were used to develop the inherent affective and mental resourcefulness and resilience of the critical care nurse. Step four entailed the description of guidelines for operationalising the model in practice to facilitate the emotional intelligence of the critical care nurse in South Africa. Evaluation of the model was undertaken according to Chinn and Kramer (1991 ). To ensure valid results a model of trustworthiness proposed by Guba (1981, in Krefting, 1999) was utilised for the macro argument for the total model. In this study ethical conduct was applied as described by Burns and Grove (2009). The limitations of the research study are highlighted in chapter seven and recommendations of the model for nursing practice, nursing research and nursing education are also made.

Background: More than 200,000 children are admitted annually to Pediatric Intensive Care Units (PICUs) in the US. Research has shown young children can provide insight into their hospitalization experiences; child reports rather than parental reports are critical to understanding the child’s experience. Information relating to children’s perceptions while still in the PICU is scarce. Aims: The purpose of this qualitative study was to investigate school age children’s and adolescents’ perceptions of PICU while in the PICU; changes in perceptions after transfer to the General Care Unit (GCU); differences in perceptions of school age children/adolescents and those with more invasive procedures. Methods: Interviews were conducted in PICU within 24-48 hours of admission and 24-48 hours after transfer to GCU. Data on demographics, clinical care and number/types of procedures were obtained. Results: Participants were 7 school age children, 13 adolescents; 10 Hispanic; 13 males. Five overarching themes: Coping Strategies, Environmental Factors, Stressors, Procedures/Medications, and Information. Children emphasized the importance of peer support and visitation; adolescents relied strongly on social media and texting. Parent visits sometimes were more stressful than peer visits. Video games, TV, visitors, and eating were diversional activities. In the PICU, they wanted windows to see outside and interesting things to see on the ceiling above them. Children expressed anticipatory fear of shots and procedures, frustration with lab work, and overwhelming PICU equipment. Number of child responses was higher in PICU (927) than GCU (593); the largest difference was in Environmental Factors. Variations between school age children and adolescents were primarily in Coping Strategies, especially in social support. Number of GCU procedures were the same (8 children) or greater (2 children) than PICU procedures. Discussion: Admission to PICU is a very stressful event. Perceptions from children while still in PICU found information not previously found in the literature. Longitudinal studies to identify children’s perceptions regarding PICU hospitalization and post-discharge outcomes are needed.

Life-support treatment is regarded as the support of vital functions of respiration and circulation such as mechanical ventilation and inotropic support, and life-sustaining therapy which incorporate therapies such as artificial hydration, nutrition and haemodialysis. Life-support treatment is rendered to critically ill patients within the intensive care units. However, when treatment options are maximised, and the patient’s condition is unchanged, a decision is often made to withdraw treatment. Professional nurses are usually involved in the process of withdrawal of life-support treatment as they care for this population of patients. The study followed a qualitative, explorative, descriptive and contextual research paradigm in order to explore and describe the perceptions of professional nurses with regard to the process of withdrawing life-support treatment in a private intensive care unit. Data was collected by means of interviews, which were transcribed according to Tesch’s method of analysis. Field notes were used to supplement the data findings. Based on the data collected, it is clear that professional nurses experience difficulties when performing withdrawal of life-support treatment. There are a number of communication concerns which need to be addressed and suggestions were also made by the interview participants regarding these concerns. The study makes recommendations to assist professional nurses with the process of withdrawing life-support treatment in a private intensive care unit. The findings of the study will be disseminated to the relevant hospital and unit managers. Ethical principles were maintained throughout the study by adhering to the principles of privacy, confidentiality, anonymity and beneficence.

Over the last three decades there has been a greater need for health care practitioners to base their decision on the best available in order to optimise quality and cost-effective patient care. Evidence-based practice necessitates guideline development, education and review in order to achieve improved patient outcomes. However, initiatives that endeavour to disseminate and implement evidence-based practice have faced barriers and opposition. Barriers that might hamper the implementation of evidence-based practice include characteristics of the evidence itself, personal, institutional or organizational factors. The research study explored and described the barriers to implementation of evidence-based practices in a critical care unit. Based on the data analysis, recommendations were made to enhance the implementation of evidence-based practices in the critical care unit. A quantitative, explorative, descriptive and contextual research design was used to operationalize the research objectives. The target population comprised professional nurses in the critical care unit. Non-probability sampling was used to obtain data by means of a structured self-administered questionnaire. Descriptive data analysis was applied, using a statistical programme and the aid of a statistician. The results are graphically displayed using bar graphs and tables. Recommendations for nursing practice, education and research were made. Ethical principles have been maintained throughout the study.

Critically ill patients often require assistance by means of intubation and mechanical ventilation to support their spontaneous breathing if they are unable to maintain it. Mechanical ventilation is one of the most commonly used treatment modalities in the care of the critically ill patient and up to 90% of patients world-wide require mechanical ventilation during some or most parts of their stay in critical care units Management of a patient’s airway is a critical part of patient care both in and out of hospital. Although there are many methods used in verifying the correct placement of the endotracheal tube, the need and ability to verify placement of an endotracheal tube correctly is of utmost importance, because many complications can occur should the tube be incorrectly placed. Since unrecognized oesophageal intubation can have many disastrous effects on patients, various methods for verifying correct endotracheal tube placement have been developed and considered. Some of these methods include direct visualization, end-tidal carbon dioxide measurement and oesophageal detector devices. This research study aimed to explore and describe the existing literature on the verification of endotracheal tubes in the mechanically ventilated patient in the critical- care unit. A systematic review was done in order to operationalize the primary objective. Furthermore, based on the literature collected from the systematic review, recommendations for the verification of the endotracheal tube in the mechanically ventilated patient in the critical care unit were made. Ethical considerations were maintained throughout the study and the quality of the systematic review was ensured by performing a critical appraisal of the evidence found.

Critical illness is typically associated with a catabolic stress state in which patients commonly demonstrate a systemic inflammatory response that brings about changes in their body systems. Changes in the body systems make the critically ill dependent on mechanical ventilation and inotropic support for longer periods in order to survive. However, this inflammatory response can be attenuated by the timely introduction of nutritional support to provide energy and nutrients to diminish catabolism and promote anabolism. The result could be a decrease in the morbidity and mortality rates, as well as the financial burden on the patients, institutions and the state. Since registered nurses initiate and utilise feeding protocols to achieve target goals, there is a strong need for nurse-initiated feeding protocols. These protocols should be coupled with a comprehensive nurse-directed nutritional educational intervention that will focus on their safe and effective implementation. This focus on nursing nutrition education represents a major shift away from traditional education which has focused on dietitians and physicians. Evidence suggests that incorporating guideline recommendations into nurse-initiated protocols for starting and advancing enteral feedings is an effective strategy to improve the delivery of nutritional support. The study was aimed at exploring the provision of nutritional support to critically ill hospitalised patients by registered nurses to identify and describe possible gaps in the practice, through determining the potential relationship between the provision of nutritional support and characteristics of its providers. A quantitative, descriptive correlational study was undertaken. Seventy registered nurses working in neonatal/paediatric and adult critical care units in two public and three private hospitals in East London in the Eastern Cape participated in the study. The sample also included public critical care students. The results showed that registered nurses in private hospitals have more knowledge about the importance of nutritional support than their public hospital counterparts and students. The mean score was on the question was 80.3% with the highest score of 91% which was for the private hospital nurses, followed by 77.2% for public and 71.4% for students. Again, the mean score for knowledge on timing of initiating nutritional support was 48%, the highest score being 69.4% for students followed by private hospital nurses with 49.6%. Close to 63% (n = 44) of these nurses were either unsure about the availability of nutritional protocols or clearly attested to their non-availability. This is seen as an issue of concern because a protocol is meant to be a standard document with which all members of the ICU should be familiar. It is meant to guide and facilitate the manner of working in the unit. While facilitation of maintenance of nutritional support to patients is the responsibility of registered nurses, according to Regulation 2598(1984) section 45 (1) (q) of the South African Nursing Council, 68% (n = 48) of the respondents felt that this was in the practising scope of doctors and dietitians. The study concluded that the nurses are knowledgeable about the importance of nutritional support but knowledge gaps have been identified as far as the timing of initiating nutritional support is concerned. Some attested to unavailability of standard guidelines that are tailored into protocols guiding the provision of nutritional support by registered nurses in the critical care units. Nutrition should be prioritised as an important therapy for improving the outcomes of critically ill patients. Nurses need to analyse its provision, identify barriers to nutritional strategies and engage in nutritional education to empower themselves regarding the practice. Most importantly, there is a need for nurse-initiated nutritional protocols that are tailored from the broad nutritional guidelines and aligned with the local context and ways of practising. Nutritional support should be included as a key component of the curriculum in academic programmes that specialise in critical care nursing.

Objective: To explore the decision making approaches used by nurses who chose to work in critical care and factors influencing the process of decision making. Design and methods Qualitative descriptive methods using semi-structured interviews with nurses who had chosen to work in critical care within the past year. Results Ten nurses weighed staying in their current positions with moving to critical care. Two nurses considered two or more specialty units. The nurses used rational-intuitive and satisficing decision making approaches in making their employment decision. Limited knowledge and unrealistic expectations of work life in critical care, pressure from others, and inadequate professional support made nurses’ employment decisions more difficult. Social support, personal values for growth and learning, and paid educational incentives within employment offers facilitated their employment decisions. Conclusions Several factors negatively influenced nurses’ decision making approaches to making an employment decision. Findings revealed the need for decision support interventions focused on making employment choices for nurses.