The critical care unit (CCU) is a unit where different health care professionals work together to care for the patient efficiently. A lot of studies in the past have shown that good communication and transfer of information from one health care professional to the other is an essential aspect in the transfer of a patients care. Most of these studies are concentrated on the reporter or informant. Lapses in communication and information transfer could result in unnecessary suffering both for the patient and for the health care worker. There are very few studies on how well the recipient of the information or report understands or comprehends the information passed. The aim of this study was to illuminate the critical care nurses (CCN) experiences of receiving report of patients transferred from other units. A qualitative design was chosen and five CCNs in a particular CCU were interviewed. The analysis was done using the content analysis method. The analysis resulted in four main categories which are: The patient’s situation-a determinant factor, the work environment, communication deficit creates uncertainty and structure enhances report and ten subcategories. The findings showed that CCNs' experience a feeling of uncertainty as a result of lapses in communication and their work environment and its attendant distractions has a great influence on the quality of the report they receive. To ensure a good quality of care that promotes patient’s safety and job satisfaction, it would be necessary to address the factors that hinder effective communication during handover in nurses' education programs and clinical practices.

Background: Getting admitted to CCU is viewed as a stressful event by patients. However, numerous studies have indicated that nurses do not always accurately perceive the stressors of their clients. Therefore, it is important for nurses to know what seems most stressful from the patients‘ perspective so that appropriate nursing measures can be directed towards minimizing such stressors. Objectives: The purpose of this study was to explore the perception of CCU stressors experienced by patients from both patients and nurses perspective and to compare between them, identify the effect of socio-demographic characteristics of participant's on the level of stress perception and to what extent clinical guidelines fulfil CCU needs. Methodology: A mixed method approach (qualitative and quantitative) was applied. Purposive random sampling was used to recruit data. Ethical approval was obtained prior to data collection. Data was collected from three CCUs within the West and Northwest NHS Trusts. Participants who met the inclusion criteria were interviewed and asked to rank the Environmental Stressor Questionnaire (ESQ). Qualitative data was analyzed using Gorgi's method of analysis. A quantitative data was analyzed using the SPSS software version 15. Results: There was some consistency in the data where patients and nurses provided same ranking for CCU stressors. Consistently nurses ranked physiological stressors higher than psychological stressors. Patients showed consistency in the findings between what they ranked in the ESQ and their narratives more than their counterparts. Perception of stress was affected by participant's socio-demographic characteristics. A key finding is that the current guidelines do not serve patients and nurses needs. Conclusions: Nurses should be well equipped with knowledge and experience to overcome stressful situations. Educational programs should be made available for nurses to improve stress management. Nurses should assess patient's needs by applying effectively communication skills.

Bakgrund: Medicintekniken blir bara mer avancerad för vart år. Sjuksköterskan använder medicintekniken dagligen i omvårdnaden. Patienten är ett subjekt, vilket betyder att den är mer än en kropp. Medicintekniken kan när den används på fel sätt av sjuksköterskan, ändra synen på patienten och göra den till ett objekt. Syfte: Syftet med denna studie var att beskriva sjuksköterskors erfarenheter av hur det är att arbeta med medicinteknik i omvårdnaden och hur sjuksköterskan anser att medicintekniken inverkar på omvårdnaden. Metod: Kvalitativ innehållsanalys användes enligt Graneheim och Lundman (2004). Data samlades in genom intervjuer med sju sjuksköterskor som arbetade på akutmottagningen. Resultat: I analysen skapades olika kategorier: Omvårdnadskompetens, krav, kvalité, förhållningssätt och omvårdnadsfokus. Konklusion: Sjuksköterskan är beroende av medicintekniken för att omvårdnaden ska fungera. Medicintekniken har en negativ effekt på omvårdnaden, ifall sjuksköterskan inte reflekterar över varför medicintekniken används från första början. / Background: The medicine technology is getting more advanced with each year. The nurse is using it daily in the care. The patient is a subject which means it is more than a body. Medical technology when used improperly by the nurse can change the view of the patient and turn the patient into an object. Purpose: The purpose of this study was to describe nurses' experiences. How it is working with medical technology in the care is and how nurses believe that medical technology impact on nursing care. Method: Qualitative content analysis was used by Graneheim and Lundman (2004). The data were collected through interviews with seven nurses that are working in a critical care unit. Result: Based on the analysis different categories were found: Caring knowledge, claims on the nurse, quality, approach and nursing focus. Conclusion: The nurse is depending on the medicine technology for the care to work. Medical technology has a negative impact on nursing care, if the nurse does not reflect on why medical technology is used in the first place.

INTRODUCTION AND AIM: The current shortage of nurses is a concern shared by the healthcare industry globally. Whilst the reasons for these shortages are varied and complex, a key factor among them seem to involve an unhealthy work environment. The demanding nature of the critical care environment presents a challenge to many nursing professionals and it carries the risk of a high turn over rate due to the stress and intensity of the critical care environment. The critical care nurse is responsible for caring for the most ill patients in hospitals and the acute shortage of critical care nurses contributes to the intensity and pressures of this environment. Little evidence exists of research conducted to explore and describe the practice environment of the critical care nurse in South Africa. The main aim of this research study was to construct a theory for positive practice environments in critical care units in South Africa, grounded in the views and perceptions of critical care nurses working in the private hospital context. In recognition of the fact that a positive practice environment is considered to be the foundation for the successful recruitment and retention of nurses, it was clear that issues related to staff shortages will not be resolved unless the unhealthy work environment of nurses is adequately addressed. RESEARCH DESIGN AND METHOD: A constructivist grounded theory design was selected to address the inquiry at hand. The study was divided into two phases and pragmatic plurality allowed the use of both quantitative and qualitative data collection methods to explore, describe and contextualise the data in order to achieve the overall aim of the study. In phase one, a checklist developed by the researcher was used to describe the demographic profile of the critical care units (n=31) that participated in the study. The perceptions of critical care nurses (n=298) regarding their current practice environment was explored and decribed by using a valid and reliable instrument, the Practice Environment Scale of the Nursing Work Index (PES-NWI). In phase two, the elements of a positive practice environment were explored and described by means of intensive interviews with critical care nurses (n=6) working in the critical care environment. Concepts related to the phenomenon under investigation were identified by means of an inductive analysis of the data through a coding process and memo-writing. One core conceptual category and six related categories emerged out of the data. In the final phase of the theoretical sampling of the literature, a set of conclusions relevant to the phenomenon under study was constructed. The conclusions deduced from the empirical findings in both phases of the research process were integrated with those derived from the literature review to provide the foundation from which the theory was constructed. FINDINGS: The findings from the first phase of the research process provided information about the context in which the participants operate and assisted in discovering concepts considered relevant to the phenomenon under investigation. A grounded theory depicting the core conceptual category of "being in controi" and its relation to the other six categories was constructed from the data in order to explain a positive practice environment for critical care units in the private healthcare sector in South Africa. / Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2010.

INTRODUCTION AND AIM: The current shortage of nurses is a concern shared by the healthcare industry globally. Whilst the reasons for these shortages are varied and complex, a key factor among them seem to involve an unhealthy work environment. The demanding nature of the critical care environment presents a challenge to many nursing professionals and it carries the risk of a high turn over rate due to the stress and intensity of the critical care environment. The critical care nurse is responsible for caring for the most ill patients in hospitals and the acute shortage of critical care nurses contributes to the intensity and pressures of this environment. Little evidence exists of research conducted to explore and describe the practice environment of the critical care nurse in South Africa. The main aim of this research study was to construct a theory for positive practice environments in critical care units in South Africa, grounded in the views and perceptions of critical care nurses working in the private hospital context. In recognition of the fact that a positive practice environment is considered to be the foundation for the successful recruitment and retention of nurses, it was clear that issues related to staff shortages will not be resolved unless the unhealthy work environment of nurses is adequately addressed. RESEARCH DESIGN AND METHOD: A constructivist grounded theory design was selected to address the inquiry at hand. The study was divided into two phases and pragmatic plurality allowed the use of both quantitative and qualitative data collection methods to explore, describe and contextualise the data in order to achieve the overall aim of the study. In phase one, a checklist developed by the researcher was used to describe the demographic profile of the critical care units (n=31) that participated in the study. The perceptions of critical care nurses (n=298) regarding their current practice environment was explored and decribed by using a valid and reliable instrument, the Practice Environment Scale of the Nursing Work Index (PES-NWI). In phase two, the elements of a positive practice environment were explored and described by means of intensive interviews with critical care nurses (n=6) working in the critical care environment. Concepts related to the phenomenon under investigation were identified by means of an inductive analysis of the data through a coding process and memo-writing. One core conceptual category and six related categories emerged out of the data. In the final phase of the theoretical sampling of the literature, a set of conclusions relevant to the phenomenon under study was constructed. The conclusions deduced from the empirical findings in both phases of the research process were integrated with those derived from the literature review to provide the foundation from which the theory was constructed. FINDINGS: The findings from the first phase of the research process provided information about the context in which the participants operate and assisted in discovering concepts considered relevant to the phenomenon under investigation. A grounded theory depicting the core conceptual category of "being in controi" and its relation to the other six categories was constructed from the data in order to explain a positive practice environment for critical care units in the private healthcare sector in South Africa. / Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2010.

Patienter som vårdas på en intensivvårdsavdelning (IVA) är allvarligt sjuka och behöver specialiserad vård. En del av den vården är ofta ventilatorbehandlingen som kan uppfattas som en mycket mentalt påfrestande upplevelse. Syftet med denna litteraturbaserade studie var att beskriva patienters upplevelser av att vårdas i ventilator på en intensivvårdsavdelning. Datamaterialet har utgjorts av kvalitativa studier med ett patientperspektiv, vilka har analyserats kvalitativt. I resultatet framkom två huvudteman; Verkliga upplevelser och Overkliga upplevelser. Subteman som framkom till Verkliga upplevelser var upplevelser av Kommunikation, Självbestämmande och kontroll samt Miljön. Overkliga upplevelser fick subteman om IVA-syndrom och upplevelser av Sedering. Patienterna upplevde ofta en brist på kontroll där den mest dominanta orsaken var svårigheten att kunna kommunicera vilket bidrog till mental ohälsa. Denna mentala ohälsa manifesterades ofta i IVA–syndrom eller liknande tillstånd där en bidragande orsak var en orolig och förvirrande miljö samt påverkan av sedering. Positiva upplevelser beskrevs och då gärna i samband med fysisk kontakt och anhörigas närvaro. Författarna diskuterar om de olika temans faktorer och sätter dessa i samband med hälsa enligt det salutogena synsättet. / Patients in need of intensive care treatment are seriously ill and require specialized care. This includes ventilator support, which can potentially be perceived as a mentally stressful experience. The aim of this literature-based study is to describe patients' experiences of ventilatory care in an intensive care setting. The collected data contains qualitative studies from a patient perspective, which have undergone qualitative analysis. The result revealed two main themes; actual experiences and perceived experiences. Subthemes for actual experiences were; Experiences of communication, Experiences of autonomy and control as well as Experiences of the environment. Subthemes for Perceived experiences were; Experiences of ICU-syndrome and Experiences of sedation. Patients frequently perceived loss of control, which was primarily associated with difficulty to communicate. This contributed to mental ill health, and often manifested as the ICU-syndrome or a similar condition. Contributing factors included the stressful and confusing environment, as well as the effects of sedation. Conversely, the positive experiences described included physical contact and the presence of relatives. The authors discuss the aforementioned categories and their contributors whilst associating these with health according to the salutogenic model.

Text in English / The purpose of this study was to develop strategies to overcome the challenges in the management of large intensive care units (ICUs). Qualitative, research was conducted to explore and describe the challenges and needs experienced by the ICU managers and critical care nurses in the management of large ICUs. Data was collected through interviews. The study was conducted in two phases, that is, Phases I and II which involved compilation of evidence in preparation for development of the strategies and development of the strategies respectively. Two groups of critical care nurses participated in the steps of data collection in Phase I of the study. The unit managers participated in Phase I step 1 which was individual interviews and the critical care nurses not in the management role participated in Phase I, step 2 which was focus group interviews. Data was analysed using the descriptive analysis method of Tesch (1990). The study has highlighted the challenges and needs in the management of large ICUs, through seven themes that emerged from the findings. Ten strategies were developed to overcome the challenges and address the identified needs. The strategies have been presented as a contribution to literature. / Health Studies / D. Litt. et Phil. (Health Studies)

Text in English / The purpose of this study was to develop strategies to overcome the challenges in the management of large intensive care units (ICUs). Qualitative, research was conducted to explore and describe the challenges and needs experienced by the ICU managers and critical care nurses in the management of large ICUs. Data was collected through interviews. The study was conducted in two phases, that is, Phases I and II which involved compilation of evidence in preparation for development of the strategies and development of the strategies respectively. Two groups of critical care nurses participated in the steps of data collection in Phase I of the study. The unit managers participated in Phase I step 1 which was individual interviews and the critical care nurses not in the management role participated in Phase I, step 2 which was focus group interviews. Data was analysed using the descriptive analysis method of Tesch (1990). The study has highlighted the challenges and needs in the management of large ICUs, through seven themes that emerged from the findings. Ten strategies were developed to overcome the challenges and address the identified needs. The strategies have been presented as a contribution to literature. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this review of literature is to explore the effects of interventional and environmental auditory stimuli on the adult critical care population. Current research has yet to compare and contrast the effectiveness of various interventional auditory stimuli on stress relief, an oversight this thesis aims to remedy. Modern day critical care settings demand the identification of the most therapeutic interventional auditory stimulus and the most stress-inducing environmental stimuli, so that interventions can be made to optimize patient stress levels and improve outcomes. Suggestions will be made on how to simultaneously reduce harmful or stress inducing auditory stimuli in the critical care setting and implement the optimal stress-relieving interventional auditory stimuli.

The aim of the study was to describe the perceptions of critical care nurses concerning family witnessed resuscitation, presenting arguments for or against the practice thereof. A quantitative, descriptive and exploratory approach was used. For the study, a non- probability convenience sample of 100 critical care nurses from five critical care units were used. A combined open-ended and closed-ended questionnaire was used. The majority of critical care nurses in the study disapproved of the idea of family witnessed resuscitation. They believed it to be traumatic for relatives, threatening to the resuscitation process and increasing litigation. Although the dominant feeling was one of disapproval, some critical care nurses felt that family witnessed resuscitation was beneficial to relatives. Recommendations for future practice included incorporation of educational programmes for critical care nurses concerning family witnessed resuscitation and providing training to deal with the stresses of family witnessed resuscitation. / Health Studies / M.A (Health Studies)