A segurança do paciente grave é uma meta da qualidade do atendimento em Unidade de Terapia Intensiva (UTI), daí a necessidade de se investigar os fatores relacionados à ocorrência de eventos adversos nesse contexto. Trata-se este estudo de uma pesquisa quantitativa, retrospectiva, analítico-transversal que teve como objetivo analisar os fatores associados aos incidentes e/ou eventos adversos (INC/EA) no preparo e administração de medicamentos, nos cuidados com tubo endotraqueal/traqueostomia, sondas, drenos, cateteres e queda em UTI segundo as características demográficas e clínicas do paciente e recursos estruturais da Unidade. Os dados foram coletados por meio dos registros de INC/EA dos prontuários dos pacientes que tiveram notificado algum tipo de INC/EA no período de 2003 e 2006, inclusive, em cinco UTI de cinco hospitais do Município de São Paulo. No tratamento estatístico, foi utilizada a análise de regressão logística multivariada para a identificação dos fatores independentes de INC/EA e condições de saída da Unidade. Para a identificação dos fatores independentes do tempo de permanência nas UTI, utilizou-se a análise de regressão linear múltipla. As variáveis que entraram nos modelos foram aquelas que apresentaram na regressão logística univariada um valor de teste Wald<0,20; em todas as análises realizadas foi utilizado o nível de significância de 5%. Do total de 21.230 admissões nas UTI, 377 (1,78%) pacientes sofreram algum tipo de INC/EA. Foram notificadas 461 ocorrências, a maioria relacionada ao preparo e administração de medicamentos (196-42,51%), seguidas aos cateteres periféricos e arteriais (105-22,77%) e às sondas nasogástricas (73-15,83%). Quanto aos fatores associados aos INC/EA e recursos materiais/equipamentos e ambiente físico das unidades, o baixo número de ocorrências (16-2,82%) inviabilizou a análise dessas variáveis. Da mesma forma, nenhum hospital dispunha das escalas diárias de enfermagem com dados retrospectivos sobre os recursos humanos existentes no período do estudo. Verificou-se que o número de dias de permanência dos artefatos terapêuticos foi um dos principais fatores independentes associados aos INC/EA quer no preparo e administração de medicamentos (número de dias de TE/Traq.), quer nos cuidados com cateter periférico, sonda nasogástrica e cateter central (número de dias de artefatos terapêuticos), seguidos da gravidade e da não sobrevivência dos pacientes. Referente ao tempo de permanência na UTI, os fatores associados foram número de dias de sondas, drenos e cateteres, número de itens da prescrição medicamentosa, não sobrevivência e INC/EA com cateteres periféricos e medicamentos. Finalizando, constatou-se que pacientes não sobreviventes tiveram maior número de dias com TE/Traq., eram mais graves e apresentaram, aproximadamente, cinco vezes mais chance de sofrer um INC/EA com TE/Traq.. Considerando que o enfoque da segurança do paciente é de responsabilidade compartilhada de todos os profissionais, da área de saúde ou não, julga-se que os resultados dessa investigação contribuam para a melhoria da assistência ao paciente crítico, por abrir perspectivas para o estabelecimento de protocolos de prevenção dessas ocorrências / The safety of serious patients is a goal of the quality of service in Intensive Care Units (ICUs), therefore, the need to investigate the factors related to the occurrence of adverse events in this context. This study reports a quantitative, retrospective, analytic-transversal research that aimed to analyze the factors associated with the incidents and/or adverse events (INC/AE) in the preparation and administration of medication, in the care of endotracheal/tracheostomy tubes, probes, drains, catheters and fall in ICUs according to the demographic and clinical characteristics of patients and structural resources of the Units. Data was collected from the registry of INC/AE made in the charts of patients that were notified with some type of INC/AE in five ICUs of five hospitals of the City of Sao Paulo from 2003 to 2006. The statistical treatment consisted of an analysis of multivariate logistic regression to identify the independent factors of INC/AE and exit conditions of the Units. The author also ran the multiple linear regression analysis to identify the independent factors of the length of stay in the ICUs. Variables that presented a Wald test rate <0,20 in the univariate logistic regression entered in the models. All analysis adopted a 5% significance level. From 21.230 total admissions in the ICUs, 377 (1,78%) patients suffered some type of INC/AE. A total of 461 occurrences were notified. Most of these occurrences were related to the preparation and administration of medication (196-42,51%), followed by the peripheral catheters and A- lines (105-22,77%), and the nasograstic tubes (73-15,83%). The low number of occurrences (16-2,82%) of factors associated with INC/AE, material/equipment resources and physical settings of the units made the analysis of these variables unfeasible. The same way, no hospital made available daily nursing schedules that contained retrospective data about the existing human resources at the time of the study. The author verified that the number of days of use of therapeutic artifacts was one of the main independent factors associated with INC/AE. These related to the preparation and administration of medication (number of days of TE/Traq.), as well as to the care of peripheral catheters, nasograstic tubes and central catheters (number of days of therapeutic artifacts), followed by seriousness and non-survival of the patients. The factors associated with the length of stay in the ICU were number of days with probes, drains and catheters, number of items of the prescribed medication, non-survival and INC/AE with peripheral catheters and medication. At last, the author established that non-survival patients spent a greater number of days with TE/Traq. They were also more serious and were about five times more likely to suffer INC/AE with TE/Traq. Considering that the focus of a patient safety is shared responsibility of all professionals, from the health field or not, the author considers that the results of this investigation contribute to the improvement of the assistance to critical patients, as it opens perspectives for the establishment of protocols for the prevention of such occurrences

A segurança do paciente grave é uma meta da qualidade do atendimento em Unidade de Terapia Intensiva (UTI), daí a necessidade de se investigar os fatores relacionados à ocorrência de eventos adversos nesse contexto. Trata-se este estudo de uma pesquisa quantitativa, retrospectiva, analítico-transversal que teve como objetivo analisar os fatores associados aos incidentes e/ou eventos adversos (INC/EA) no preparo e administração de medicamentos, nos cuidados com tubo endotraqueal/traqueostomia, sondas, drenos, cateteres e queda em UTI segundo as características demográficas e clínicas do paciente e recursos estruturais da Unidade. Os dados foram coletados por meio dos registros de INC/EA dos prontuários dos pacientes que tiveram notificado algum tipo de INC/EA no período de 2003 e 2006, inclusive, em cinco UTI de cinco hospitais do Município de São Paulo. No tratamento estatístico, foi utilizada a análise de regressão logística multivariada para a identificação dos fatores independentes de INC/EA e condições de saída da Unidade. Para a identificação dos fatores independentes do tempo de permanência nas UTI, utilizou-se a análise de regressão linear múltipla. As variáveis que entraram nos modelos foram aquelas que apresentaram na regressão logística univariada um valor de teste Wald<0,20; em todas as análises realizadas foi utilizado o nível de significância de 5%. Do total de 21.230 admissões nas UTI, 377 (1,78%) pacientes sofreram algum tipo de INC/EA. Foram notificadas 461 ocorrências, a maioria relacionada ao preparo e administração de medicamentos (196-42,51%), seguidas aos cateteres periféricos e arteriais (105-22,77%) e às sondas nasogástricas (73-15,83%). Quanto aos fatores associados aos INC/EA e recursos materiais/equipamentos e ambiente físico das unidades, o baixo número de ocorrências (16-2,82%) inviabilizou a análise dessas variáveis. Da mesma forma, nenhum hospital dispunha das escalas diárias de enfermagem com dados retrospectivos sobre os recursos humanos existentes no período do estudo. Verificou-se que o número de dias de permanência dos artefatos terapêuticos foi um dos principais fatores independentes associados aos INC/EA quer no preparo e administração de medicamentos (número de dias de TE/Traq.), quer nos cuidados com cateter periférico, sonda nasogástrica e cateter central (número de dias de artefatos terapêuticos), seguidos da gravidade e da não sobrevivência dos pacientes. Referente ao tempo de permanência na UTI, os fatores associados foram número de dias de sondas, drenos e cateteres, número de itens da prescrição medicamentosa, não sobrevivência e INC/EA com cateteres periféricos e medicamentos. Finalizando, constatou-se que pacientes não sobreviventes tiveram maior número de dias com TE/Traq., eram mais graves e apresentaram, aproximadamente, cinco vezes mais chance de sofrer um INC/EA com TE/Traq.. Considerando que o enfoque da segurança do paciente é de responsabilidade compartilhada de todos os profissionais, da área de saúde ou não, julga-se que os resultados dessa investigação contribuam para a melhoria da assistência ao paciente crítico, por abrir perspectivas para o estabelecimento de protocolos de prevenção dessas ocorrências / The safety of serious patients is a goal of the quality of service in Intensive Care Units (ICUs), therefore, the need to investigate the factors related to the occurrence of adverse events in this context. This study reports a quantitative, retrospective, analytic-transversal research that aimed to analyze the factors associated with the incidents and/or adverse events (INC/AE) in the preparation and administration of medication, in the care of endotracheal/tracheostomy tubes, probes, drains, catheters and fall in ICUs according to the demographic and clinical characteristics of patients and structural resources of the Units. Data was collected from the registry of INC/AE made in the charts of patients that were notified with some type of INC/AE in five ICUs of five hospitals of the City of Sao Paulo from 2003 to 2006. The statistical treatment consisted of an analysis of multivariate logistic regression to identify the independent factors of INC/AE and exit conditions of the Units. The author also ran the multiple linear regression analysis to identify the independent factors of the length of stay in the ICUs. Variables that presented a Wald test rate <0,20 in the univariate logistic regression entered in the models. All analysis adopted a 5% significance level. From 21.230 total admissions in the ICUs, 377 (1,78%) patients suffered some type of INC/AE. A total of 461 occurrences were notified. Most of these occurrences were related to the preparation and administration of medication (196-42,51%), followed by the peripheral catheters and A- lines (105-22,77%), and the nasograstic tubes (73-15,83%). The low number of occurrences (16-2,82%) of factors associated with INC/AE, material/equipment resources and physical settings of the units made the analysis of these variables unfeasible. The same way, no hospital made available daily nursing schedules that contained retrospective data about the existing human resources at the time of the study. The author verified that the number of days of use of therapeutic artifacts was one of the main independent factors associated with INC/AE. These related to the preparation and administration of medication (number of days of TE/Traq.), as well as to the care of peripheral catheters, nasograstic tubes and central catheters (number of days of therapeutic artifacts), followed by seriousness and non-survival of the patients. The factors associated with the length of stay in the ICU were number of days with probes, drains and catheters, number of items of the prescribed medication, non-survival and INC/AE with peripheral catheters and medication. At last, the author established that non-survival patients spent a greater number of days with TE/Traq. They were also more serious and were about five times more likely to suffer INC/AE with TE/Traq. Considering that the focus of a patient safety is shared responsibility of all professionals, from the health field or not, the author considers that the results of this investigation contribute to the improvement of the assistance to critical patients, as it opens perspectives for the establishment of protocols for the prevention of such occurrences

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)

by Chow Wai-hung. / Thesis (M.B.A.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 56-57). / ABSTRACT --- p.ii / TABLE OF CONTENTS --- p.iv / LIST OF FIGURES --- p.vi / LIST OF TABLES --- p.vii / ACKNOWLEDGMENT --- p.viii / Chapter / Chapter I. --- INTRODUCTION --- p.1 / Intensive Care Services --- p.1 / Clinician as an Information Processor --- p.2 / Executive Information System (EIS) for Intensive Care Services --- p.7 / Scope of the Study --- p.7 / The Organization of the Remaining Report --- p.8 / Chapter II. --- LITERATURE REVIEW --- p.9 / Sickness Scoring Systems --- p.9 / Executive Information Systems (EIS) --- p.15 / Information Requirements Determination for EIS --- p.17 / Future Direction of EIS in Intensive Care --- p.20 / Chapter III. --- RESEARCH METHODOLOGY --- p.22 / Survey by Mailed Questionnaire --- p.23 / Personal Interview --- p.24 / Subjects Selection --- p.26 / Analysis --- p.27 / Chapter IV. --- RESULTS AND FINDINGS --- p.28 / Part 1 - Questionnaires --- p.29 / Part 2 - Interviews --- p.31 / Chapter V. --- ANALYSIS AND DISCUSSION --- p.44 / Analysis of Results and Findings --- p.44 / Evaluation on Information Requirements Determination for an EIS --- p.50 / Chapter VI. --- CONCLUSION --- p.52 / Chapter VII. --- FUTURE DIRECTION OF DECISION SUPPORT IN CRITICAL CARE --- p.54 / REFERENCES --- p.56 / INTERVIEWS --- p.59 / APPENDIX --- p.60 / Chapter 1. --- A Sample of Hospital Information System Requirement Survey Questionnaire --- p.61 / Chapter 2. --- Samples of Visual Display --- p.67 / Chapter 3. --- A Sample of Format of a Structured Report --- p.70

by Leung Ho-Yin. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (leaves 82-89). / Abstract --- p.ii / Table of Contents --- p.iv / LIST of Figures --- p.viii / List of Tables --- p.ix / Acknowledgments --- p.xi / Chapter / Chapter 1. --- Introduction --- p.1 / Chapter 1.1 --- Intensive Care Unit --- p.2 / Chapter 1.1.1 --- Expensive Costs of Intensive Care --- p.2 / Chapter 1.1.2 --- Tremendous Demands with Limited Resources --- p.3 / Chapter 1.1.3 --- Conflicting Roles of ICU Physicians --- p.3 / Chapter 1.1.4 --- Disorganized Patient Information --- p.4 / Chapter 1.2 --- ICU Management Problems --- p.5 / Chapter 1.3 --- Executive Information Systems (EIS) for ICU Physician --- p.6 / Chapter 1.4 --- Determine Information Requirements of the EIS --- p.7 / Chapter 1.5 --- Scope of the Study --- p.8 / Chapter 1.6 --- Organization of the Report --- p.8 / Chapter 2. --- Literature Review --- p.9 / Chapter 2.1 --- Intensive Care Unit --- p.9 / Chapter 2.1.1 --- Costs of ICU --- p.10 / Chapter 2.2 --- ICU Physicians are Executives --- p.10 / Chapter 2.3 --- Computers in ICU --- p.11 / Chapter 2.3.1 --- Record Keeping --- p.11 / Chapter 2.3.2 --- Data Management --- p.12 / Chapter 2.3.3 --- Decision Making --- p.13 / Chapter 2.4 --- Problems Facing ICU Physicians --- p.14 / Chapter 2.4.1 --- Conflicting Role --- p.14 / Chapter 2.4.2 --- Information Overload --- p.14 / Chapter 2.4.3 --- Poor Information Quality --- p.15 / Chapter 2.4.4 --- Technophobia --- p.16 / Chapter 2.5 --- Executive Information Systems --- p.16 / Chapter 2.5.1 --- Definition --- p.16 / Chapter 2.5.2 --- Characteristics of EIS --- p.17 / Chapter 2.5.3 --- EIS in Healthcare Industry --- p.20 / Chapter 2.6 --- Determining Information Requirements --- p.20 / Chapter 2.6.1 --- Strategies and Methods to Determine Information Requirements --- p.21 / Chapter 2.6.2 --- Critical Success Factors Analysis --- p.25 / Chapter 2.6.2.1 --- Definition of CSFs --- p.26 / Chapter 2.6.2.2 --- Different Executives Have Different CSFs and Different Information Needs --- p.26 / Chapter 2.6.2.3 --- Hierarchical Nature of CSFs --- p.26 / Chapter 2.6.2.4 --- Steps in the CSFs Approach --- p.28 / Chapter 2.6.2.5 --- "Critical Information, Assumptions, and Decisions" --- p.29 / Chapter 3. --- Research Methodology --- p.31 / Chapter 3.1 --- Literature Review --- p.31 / Chapter 3.2 --- Design a Methodology for Information Requirements Determination --- p.32 / Chapter 3.3 --- ICU Admission Case Study --- p.34 / Chapter 3.4 --- Analysis and Validation --- p.35 / Chapter 3.5 --- COPD Survey: The Importance of Medical History --- p.36 / Chapter 3.5.1 --- Chronic Obstructive Pulmonary Disease --- p.36 / Chapter 3.5.2 --- The Survey --- p.38 / Chapter 4. --- A Three-Stage Methodology --- p.41 / Chapter 4.1 --- Stage 1 - Understanding ICU Operations --- p.42 / Chapter 4.2 --- Stage 2 - Determine CSFs within the ICU --- p.43 / Chapter 4.2.1 --- CSFs Analysis Steps in the Study --- p.44 / Chapter 4.2.2 --- Step 1: Determine CSFs of ICUs --- p.44 / Chapter 4.2.3 --- Step 2: Determine CSFs of the ICU Physicians --- p.45 / Chapter 4.2.4 --- Step 3: Determine CSFs of the ICU Admission --- p.45 / Chapter 4.3 --- Stage 3 譯 Determine Information Requirements --- p.45 / Chapter 4.4 --- Importance of Medical History: A COPD Survey --- p.46 / Chapter 4.4.1 --- COPD Questionnaire --- p.46 / Chapter 5. --- Findings --- p.48 / Chapter 5.1 --- Findings in Stage 1 --- p.48 / Chapter 5.1.1 --- Decision Making in ICU --- p.49 / Chapter 5.2 --- Findings in Stage 2 - CSFs --- p.54 / Chapter 5.2.1 --- CSFs of the ICU --- p.54 / Chapter 5.2.2 --- CSFs of the ICU Physicians --- p.56 / Chapter 5.2.3 --- CSFs of the ICU Admission --- p.56 / Chapter 5.3 --- Findings in Stage 3 --- p.58 / Chapter 5.3.1 --- Types of Information Requirement --- p.58 / Chapter 5.3.2 --- Detailed Contents of the Information Requirements --- p.59 / Chapter 6. --- Analysis --- p.65 / Chapter 6.1 --- A Three-Stage Methodology for Information Requirements Determination --- p.65 / Chapter 6.1.1 --- Comparison of the Three-Stage Methodology with CSFs Analysis --- p.66 / Chapter 6.1.2 --- A Case Study Using the Three-Stage Methodology --- p.67 / Chapter 6.2 --- Roles of Information Types in Admission Decision --- p.68 / Chapter 6.2.1 --- Admitting Patients from Different Sources --- p.69 / Chapter 6.2.2 --- Admitting Patients with Different Diseases --- p.70 / Chapter 6.3 --- The Importance of Medical History --- p.71 / Chapter 7 --- Conclusions --- p.78 / Bibliography --- p.82 / Interviews --- p.90 / Appendices --- p.91

Thesis (M.S.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-04, page: 2056. Adviser: Maureen Sanderson. Includes bibliographical references.

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)

Submitted in fulfilment of the Master's Degree in Clinical Technology, Durban University of Technology, 2010. / Introduction: The aim of this study was to establish the most reliable standard method for monitoring endotracheal tube cuff pressure in an intensive care unit. Methodology: The study was conducted at King Edward VIII Hospital ICU on adult patients undergoing prolonged intubation of more than 24 hours. Consent was obtained from the patient’s next of kin. The patient’s Pcuff for this study was recorded in two ways simultaneously for a period of 12 hours during the day. The principal investigator recorded the Pcuff thrice during the study period using the Posey cufflator®. Continuous recording was done using a pressure transducer connected to the Nihon Kohden BSM®. Factors causing changes in Pcuff were also documented. Results: Thirty-five critically ill adult patients were enrolled into the study. Nineteen (54.3%) of the subjects were male. Seventeen out of 35 subjects were studied for the entire 720 minute period. The mean time of study of the group was 667 minutes with the lowest period being 135 minutes for one patient. The group mean ± Standard deviation (SD) was 26.6 8.7 with a 95% confidence index of 9.2 – 44.0 and the median value was 25 for continuous readings. For the entire group, 13% of the time was spent in the low pressure range (< 20 cmH2O), while 23% was spent in the high pressure (> 30 cmH2O). A mean of 64% of the time was spent in the normal pressure range. Overall, the most frequently encountered events that caused pressure changes were body movement, coughing, head movement and suctioning accounting for 26.2%, 20.1%, 19.2% and 9.4% respectively. For intermittent readings, the mean ± SD of all patients for T0 was 25.3 ± 6.9; for T6 25.9 ± 8.7 and for T12 24.8 ± 3.8. The overall mean ± SD for all readings was 25.6 ± 7.1. For the entire group, 12% of the time was spent in the low pressure range (< 20 cmH2O), while 5% was spent in the high pressure (> 30 cmH2O). A mean of 83% of the time was spent in the normal pressure range. The correlation between intermittent pressure and the continuous reading at the same time was r = 0.87. iii Discussion: Continuous monitoring of Pcuff indicated that the endotracheal cuff pressure varies extensively during mechanical ventilation in critically ill patients, such variation being noted both between patients and within an individual patient. In an attempt to compare intermittent and continuous monitoring of endotracheal cuff pressures, a good correlation between the two measurements was demonstrated. However, the variations in pressures noted for an individual patient would not have been detected if endotracheal cuff pressures were monitored intermittently. Hence, with continuous monitoring the pressure changes may be detected early. Conclusion: Continuous monitoring of cuff pressure during mechanical ventilation in intensive care units is thus recommended for all patients. If intermittent monitoring is performed, it should be more frequently than eight-hourly. It is recommended that a pressure range of 20-30 cmH2O still be used as the normal range. The role of self adjusting pressure devices, although needing further exploration, holds much promise. / DUT Postgraduate Development Services.

Thesis (MCur (Nursing Science))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: The work environment in critical care units in South Africa is hampered by a profound shortage of nurses, heavy workloads, conflict, high levels of stress, lack of motivation and dissatisfaction among the staff. The task of managing a C.C.U. has therefore become a challenge. It is important that unit managers apply a leadership style that matches these challenges. The aim of this study was to investigate the ideal style of leadership. The objectives set for the study were to identify the ideal leadership style required in the following areas:  administrative functions  education functions  patient care  research An explorative, descriptive research design was applied, with a quantitative approach to determine the ideal leadership style for unit managers in critical care units of private health care institutions. The research sample consisted of all nurses working permanently in eleven private hospitals in the Cape Metropolitan area. A questionnaire consisting of predominantly closed questions was used for the collection of data, which was collected by the researcher in person. Ethical approval was obtained from the Committee of Human Science Research at Stellenbosch University. Permission to conduct the research was obtained from the institutions and informed consent from the participants. A pilot study was conducted to test the questionnaire at a private hospital which did not form part of the study. A 10% sample of the relevant staff, namely 27 participants were involved in this study. The validity and reliability was assured through the pilot study and the use of a statistician as well as experts in nursing and a research methodologist. Data was tabulated and presented in histograms and frequencies. Statistical significant associations were drawn between variables, using the Chi-square test. The Spearman rank (rho) order correlation was used to show the strength of the relationship between two continuous variables. Findings of the study show that participatory leadership style and transformational leadership approach were valued in all four (4) of the objectives. Emphasis was placed on consultation prior to any decisions. Nurses requested an opportunity to give feedback on a regular basis regarding the unit managers conduct (Chi-square test p = 0.025). They also agreed that unit managers should apply the necessary rules and procedures (Chi-square test p = 0.016). A huge request was made for integrity, trust, impartiality, openness, approachability and particularly honesty. The nurses also maintained that the nurse manager’s behaviour should be congruent. Furthermore, the results indicate that nurses would like to be empowered by:  being involved in the scheduling of off-duties  taking the lead in climate meetings  being granted opportunities (to all categories of nurses) to attend managerial meetings. N = 41 (48.2%) of nurses admitted that unit managers would instruct them to cope with insufficient staffing pertaining to ventilated patients, putting them under severe strain and at risk legally. N = 39 (47%) of nurses admitted that unit managers only consider qualifications and experience in the delegation of tasks if the workload in the unit justifies it. Safe patient care is not always a priority. N = 99 (96%) of nurses agreed that autocratic behaviour relating to task delegation exists. Recommendations included the application of transformational leadership and participatory management. The aim to create a healthier, more favourable work environment for critical care nurses will hopefully be attained through applying the ideal leadership style and leadership approach. / AFRIKAANSE OPSOMMING: Die werksverrigtinge in kritieke sorgeenhede in Suid-Afrika word deur ‘n ernstige tekort aan verpleegsters, hoë werklading, konflik, spanning, min motivering en baie ontevredenheid onder verpleeglui gekortwiek. Die leiding en bestuur van ‘n kritieke sorgeenheid is dus nie ‘n maklike taak nie. Dit is dus belangrik dat eenheidsbestuurders ‘n leierskapstyl aan die dag lê wat dié uitdagings doeltreffend aanspreek. Die doel van die studie is dus om ondersoek in te stel na die wenslike leierskapstyl vir kritieke sorgeenhede. Die doelwitte daargestel is dus om die ideale leierskapstyl in elk van die volgende funksies te bepaal:  administrasie  opleiding  pasiënte-sorg  navorsing Die ideale leierskapstyl vir eenheidbestuurders in kritieke sorgeenhede in privaathospitale is bepaal deur ‘n kwantitatiewe benadering met ‘n beskrywende ontwerp toe te pas. Die populasie het alle kritieke sorg verpleeglui ( permanent werksaam by een van elf privaathospitale in die Kaapse Metropool) ingesluit. Instrumentasie het ‘n vraelys behels (met oorwegend geslote vrae) en data is persoonlik deur die navorser ingevorder. Etiese toestemming is vanaf die Etiese Komitee van die Mediese Fakulteit te Universiteit Stellenbosch verkry asook die hoofde van die verskillende privaathospitale waar navorsing plaasgevind het. Ingeligte toestemming is ook van elkeen van die deelnemers verkry. Ten einde die vraelys te toets, is ‘n loodstudie by ‘n privaathospitaal ( wat nie by die studie ingesluit was nie) gedoen. Die loodstudie het N = 27 (10%) van die totale populasie behels. Die betroubaarheid en geldigheid van die studie is deur die loodstudie, die gebruik van ‘n statistikus, verpleegdeskundiges en die navorser-metodoloog versterk. Data is getabuleer en in histogramme en frekwensies voorgestel. Deur die Chi-square- toets te gebruik, is statisties betekenisvolle assosiasies tussen veranderlikes bepaal. Ten einde sterkte van verhoudings tussen twee opeenvolgende veranderlikes te bepaal, is die Spearman rangordekorrelasie (rho) aangewend. Die bevindings van die studie het getoon dat ‘n deelnemende bestuurstyl en transformasie-leierskapbenadering die mees aangewese keuse vir al vier doelwitte is. Die toepassing van veral ‘n deelnemende besluitnemingsproses het groot voorrang geniet, Verpleegkundiges wil daarbenewens ook op ‘n gereelde basis geleentheid hê om terugvoering oor die leierskapgedrag van die eenheidsbestuurder te gee (Chi-square toets p = 0.025). Ook verlang die deelnemers dat eenheidsbestuurders nie reëls en regulasies moet verontagsaam nie (Chi-square toets p = 0.016). ‘n Ernstige versoek is gerig ten opsigte van integriteit met pertinente verwysing na eerlikheid, vertroue, onpartydigheid, deursigtigheid, toeganklikheid en dat die leier se woorde en dade moet ooreenstem. Die resultate het verder getoon dat verpleegsters graag bemagtig wil word deur:  betrokkenheid in die skedulering van afdienste,  leiding in klimaatsvergaderings te wil neem,  geleentheid te hê om bestuurvergaderings by te woon (alle kategorieë van verpleegkundiges).. N = 39 (48.2%) van verpleegkundiges het erken dat hulle gedwonge personeeltekorte ten opsigte van geventileerde pasiënte ervaar en dus aan mediese geregtelike risiko’s en onnodige druk blootgestel word. N 39 (47%) van verpleegkundiges het erken dat eenheidsbestuuders kwalifikasies en ondervinding slegs in ag neem indien die werklading in die eenheid dit toelaat..Veilige pasiëntesorg kry dus nie altyd voorkeur nie. N = 99 (96%) van verpleegkundiges het erken dat outokratiese gedrag ( wat met werkstoewysing verband hou) wel voorkom. ‘n Transformasie leierskapsbenadering en deelnemende bestuurstyl is dus aanbeveel. Die hoop word dus uitgespreek dat deur aan die verpleegkundiges se versoeke ten opsigte van die ideale bestuursbenadering en bestuurstyl te voldoen, die werksatmosfeer binne kritieke sorgeenhede toenemend gesonder en dus aangenamer sal word.

Thesis (MCur (Interdisciplinary Health Sciences. Nursing Science))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Critical care nursing is the specialty within nursing that deals with an individual's response to life-threatening problems. These life threatening problems require continuous in-depth assessment and intense therapeutic measures and interventions. The level of nursing care is intense and the amount of documentation is enormous in the intensive care unit. Failure to document any aspects, may threaten the continuity of care and patient safety. Furthermore, it may result in negligence that may result in litigation. The purpose of this study was to retrospectively analyse nursing documentation in the intensive care units of an academic hospital in the Western Cape. The objectives set for this study were to determine whether the documentation of the: • assessment of the patients were adequate; • diagnoses were based on the assessment; • nursing care plans were based on the diagnoses; • nursing care plans were implemented and • nursing care plan shows evidence of continuous evaluation A retrospective exploratory- descriptive research design with a quantitative approach was applied to audit objectively the status of nursing documentation of patients who were admitted to the ICU’s of an academic hospital in the Western Cape in the first 48 hours of admission. Ethical approval was obtained from the University of Stellenbosch and consent from the Chief Executive Officer of the academic hospital to conduct the research in the hospital under study. The research population (N) was the documentation (files) of patients admitted in the ICU’s between 1 July 2008 and 31 December 2008. A stratified sample was drawn consisting of 151 files. The researcher collected the data personally utilising a pretested audit instrument. The reliability and validity was assured through experts in nursing science and intensive care nursing, a statistician and a research methodologist. A pilot study was conducted to pretest the instrument and the feasibility of the study. Modifications to the instrument were done based on suggestions from the experts and findings of the pilot study. Data analysis included statistical associations between variables using the Chi-square test on a 95% confidence level. Data is presented in the form of figures, tables and frequencies. The findings of the study show that the nursing documentation in the intensive unit is inadequate with the following total mean scores: • Assessment 62.6% • Nursing diagnosis 53.1% • Nursing care plans 37.1% • Implementation 72.6% • Evaluation 40.5%. In conclusion nursing documentation of patients admitted to an ICU is inadequate during the first 48 hours of admission. Poor documentation threatens the safety of patients and demands urgent improvement. Recommendations to improve the documentation include nursing practice supervision, quality improvement programmes, in-service training, evidence based practice and further research. / AFRIKAANSE OPSOMMING: Kritieke-sorg verpleging is die spesialiteit in verpleging wat betrekking het op die individu se reaksie.op lewensgevaarlike probleme.Hierdie lewensgevaarlike probleme benodig deurlopend deeglike beraming en intense terapeutiese benaderings en intervensies. In die intensiewesorg eenheid is die vlak van verpleegsorg baie intens en die dokumentasie hoeveelheid is enorm. Versuim om enige aspekte van sorg deeglik en akkuraat te dokumenteer, kan die deurlopendheid van sorg sowel as die veiligheid van die pasient bedreig. Verder kan dit tot regsstappe lei as gevolg van nalatigheid. Die doel van hierdie studie was om ‘n retrospektiewe analise van verpleeg dokumentasie in die intensiewe sorgeenhede van ‘n akademiese hospitaal in die Wes Kaap te doen. Die doelwitte van hierdie studie was om vas te stel of die dokumentasie van die: • beraming van die pasiênt voldoende gedoen is • verpleegdiagnose gebaseer is op die beraming • verpleegsorgplan gebaseer is op die diagnose • implementering van die verpleegsorgplan en • verpleegsorgplan bewyse toon. van deurlopende evaluasie ‘n Retrospektiewe eksploratiewe-beskrywende navorsingsontwerp met ‘n kwantitatiewe benadering is toegepas ten einde die status van verpleegdokumentasie van pasiente wat toegalaat is tot die intensiewesorg eenhede van ‘n akademiese hospitaal in die Wes Kaap in die eerste 48 uur na toelating te bepaal. Etiese goedkeuring is verkry van die Universiteit van Stellenbosch asook vanaf die Hoof Uitvoerende Beampte van die akademiese hospitaal om die navorsing daar uit te voer. Die navorsings populasie (N) was die dokumentasie (lêers) van die pasiente wat opgeneem is in die intensiewesorg eenheid tussen 1 Julie 2008 en 31 Desember 2008. ‘n Gestratifieerde steekproef is getrek bestaande uit 151 lêers. Die navorser het die data persoonlik kollekteer deur gebruik te maak van ‘n voortoets oudit instrument. Die betroubaarheid en geldigheid is verseker deur kundiges in verpleegkunde en intensiewesorg verpleging, asook ‘n statistikus en ‘n navorsingsmetodoloog. ‘n Loodstudie is gedoen om die instrument vooraf te toets en om die uitvoerbaarheid van die navorsing te bepaal. Veranderinge is aangebring op grond van die voorstelle van die kundiges sowel as die bevindinge van die loodstudie. Data analise het ingesluit die statistiese assosiasies tussen veranderlikes deur gebruik te maak van die Chi-kwadraat toets tot ‘n 95% sekerheidsvlak. Data is aangebied in die vorm van figure, tabelle en frekwensies. Die bevindinge van die studie wys dat die verpleegdokumentasie in die intensiewesorg eenheid is onvoldoende met die volgende gemiddelde telling: • Beraming 62.6% • Verpleegdiagnose 53.1% • Verpleegsorgplanne 37.1% • Implementering 72.6% • Evaluering 40.5% Ten slotte, verpleegdokumentasie van pasiënte wat tot die intensiewesorg eenheid toegelaat is, is onvoldoende gedurende die eerste 48 uur van toelating. Swak dokumentasie bedreig die veiligheid van pasiënte en verg dringende verbetering. Aanbevelings om die dokumentasie te verbeter sluit in toesig oor verpleegpraktyke kwaliteit verbeteringsprogramme, indiensopleiding, bewysgebaseerde praktyke en verdere navorsing.