A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science in Nursing Johannesburg, 2017 / The purpose of this study was to describe the role of specialist nurses in mechanical ventilation management. The intention of the study was also to make recommendations for clinical practice and education of intensive care nurses. The setting of the study was ten (n = 10) adult intensive care units of two public hospitals in the Gauteng province. Included were trauma ICUs, cardiothoracic ICU, coronary care ICUs, major burns ICU, major injuries ICU, neurosurgery ICU and multidisciplinary ICUs. A non-experimental, descriptive, quantitative and cross-sectional survey design was used to describe the specialist nurses role in ventilation management. The final sample comprised 110 (out of 165) respondents, which yielded a response rate of 66.6% for the study. Data were collected from specialist intensive care nurses using a validated questionnaire developed by Rose et al. (2011). Data was analysed using descriptive (frequencies, means and standard deviation) and comparative statistical tests using t-tests and Chi-square analysis. Testing was done at the 0.05 level of significance. Of the 165 surveys distributed, 110 were returned (response rate 66.6%). Ninety-seven percent stated that a 1:1 ratio was used for patients receiving mechanical ventilation. Eighty-nine percent reported ventilation education for nurses was provided during ICU orientation, and 86.4% indicated ICUs provided opportunities for on-going ventilation education. Eighty-six percent of nurses reported that they had not worked in ICUs with automated weaning modes. Fifty-nine percent stated that weaning protocols were present in ICUs, and 56.4% reported the presence of protocols for weaning failure. Most nurses agreed that nurses and doctors collaborated in key ventilation decisions, but not when decisions to extubate and initial ventilation settings are made. This study showed a marginal (2%) number of nursing autonomous input made in key ventilator decisions. Seventy percent of nurses in this study agreed that responsibility for ventilation decisions lies at the level of senior registrars and above, and in their absence, only senior nurses (>80%) were perceived to be responsible for key ventilator decisions. Regarding independent titrations of ventilator settings, without medical consultation, findings showed that nurses in this study reported a frequency of >50% of the time for titration of respiratory rate, tidal volume, decreasing pressure support, increasing pressure support, titration of inspiratory pressure and ventilation mode changes. The self-perceived nursing autonomy and influence in decision making revealed a median score of 7 out of 10 points, respectively. Nurses with higher levels of autonomy, influence in decision making and years of experience scores, frequently (>50% of the time) made independent changes to ventilation settings (p<0.05). Conversely, nurses with fewer years of experience scores, infrequently (<50% of the time) made independent changes to ventilation settings without first checking with the doctor. The study concludes that nurses to re-evaluate their role in ventilation management and focus on key ventilation settings, nurses could strengthen their contribution in the collaboration of key ventilator settings. Recommendations are made for clinical practice and education of specialist nurses. / MT2018

M.Sc.(Nursing), Faculty of Health Sciences, University of the Witwatersrand, 2012 / The purpose of this study was to describe family members’ opinions regarding the quality of care and decision-making in the adult intensive care units. A quantitative descriptive research design was utilized to meet the study objectives. Structured interviews were conducted using the FS-ICU (24) questionnaire with participants (family members, n=100) drawn from three intensive care units. Descriptive and comparative statistics were used to analyse the data. Satisfaction with care was rated by family members’ as higher than their satisfaction with decision-making. Overall 91.0% (n=91) of family members’ were mostly satisfied with the care provided. Of the 24 items the management of patient symptoms was the most highly rated items. The least satisfied item related to the waiting room, which was rated as 93.0% (n=93) dissatisfactory. Frequency of communication, completeness of information, feeling excluded and unsupported during decision-making and the rigid visiting hours were areas identified for improvement in the ICU. These findings suggest that deficiencies exist in meeting family’ needs. Based on the research findings, it can be concluded that results of this study have supported the existing evidence in literature from previous studies on family satisfaction with care and decision-making in the ICU. Recommendations for nursing practice, education, research and institution are proposed.

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

MSc, Nursing, Faculty of Health Sciences, University of the Witwatersrand, 2009

Acute kidney injury (AKI) is serious and complicates up to 1 in 7 hospital admissions. It is usually diagnosed from rapidly deteriorating blood tests. Much of the focus of clinical research into AKI has been on strategies to improve recognition and timely intervention. However, emerging evidence suggests that even when people survive AKI, they remain at an elevated risk of poor long-term outcomes. The aim of this thesis was to determine which people with AKI have an ongoing increased risk of poor outcomes (mortality, kidney failure, recurrent illness episodes) after hospital discharge. The design was a population-based data-linkage cohort study involving the Grampian Laboratory Outcomes Morbidity and Mortality Study (GLOMMS-II). Data linkages included population biochemistry, hospital episode data, mortality records, intensive care records and renal registry data from 1999-2013. A cohort of 17,630 people hospitalised in 2003 were followed through to 2013. Outcomes were mortality, progression of kidney disease and unplanned hospital readmission episodes. There have been several novel research outputs. I evaluated and adapted international AKI criteria for use in large population biochemistry datasets. I developed a clinical risk prediction model for unplanned readmissions after hospital discharge, for which AKI was a strong independent predictor. I described long-term survival after AKI, showing that people with AKI (vs no AKI) have a substantially higher risk of death in the first year, but diminishing excess risk thereafter. Finally, I conducted a novel analysis of renal prognosis after AKI, showing that mortality and non-recovery are more common than subsequent renal progression after AKI, but that renal progression is nevertheless increased after AKI. Overall, AKI is a serious condition and marker of people who have a long lasting poorer prognosis. The first year after discharge is a period of particularly heightened risk that could potentially be targeted with initiatives to improve care.

Thesis (MPH.) -- University of Limpopo, 2018 / Background: Pregnant women expect a normal pregnancy, a normal delivery and a healthy baby. Unfortunately, premature birth is a common occurrence; ithas some complications and causes death in developing countries. Mothers feel disappointed for not carrying their pregnancies to term and worry about the survival of their babies. Admission into neonatal intensive care unit increases chances of baby survival but has emotional impact on mothers, thus the need to explore their experiences. Objective: To explore the lived experiences of mothers regarding their first exposure to their premature babies admitted in neonatal intensive care unit. Methods: A qualitative and exploratory study using semi-structured interviews with purposively selected mothers was conducted. Interviews were conducted in English using an interview guide, audio recorded and continued until data saturation was reached, thus 8 mothers participated in the study. Field notes were collected. Voice recordings were transcribed verbatim and analysed thematically. An independent coder confirmed the findings. Results: Mothers experienced stress and anxiety, and felt neglected by health care workers. They felt the focus was on the baby alone and the mothers’ needs ignored, though others were happy that they were welcomed. Conclusions: Therefore, parents need support when their premature babies are admitted in neonatal an intensive care unit. Continuous update on conditions of their babies is also necessary. / AMREF Health Africa, and Limpopo Department of Health

Palliative health care is offered to any patient experiencing a life limiting or life changing illness. The palliative approach includes goals of care, expert symptom management, and advance care planning in order to reduce patient suffering. Complex care can be provided by palliative care specialists while primary palliative care can be given by educated staff nurses. However, according to the literature, intensive care unit (ICU) nurses have demonstrated a lack of knowledge in the provision of primary care as well as experiencing moral distress from that lack of knowledge. In this doctor of nursing practice staff education project, the problem of ICU nurses' lack of knowledge was addressed. Framed within Rosswurm and Larrabee's model for evidence-based practice, the purpose of this project was to develop an evidence-based staff education plan. The outcomes included a literature review matrix, an educational curriculum plan, and a pretest and posttest of questions based on the evidence in the curriculum plan. A physician and a master's prepared social worker, both certified in palliative care, and a hospital nurse educator served as content experts. They evaluated the curriculum plan using a dichotomous 6-item format and concluded that the items met the intent of the objectives. They also conducted content validation on each of the pretest/posttest items using a Likert-type scale ranging from 1 (not relevant) to 4 (very relevant). The content validation index was 0.82 indicating that test items were relevant to the educational curriculum objectives. Primary palliative care by educated ICU nurses can result in positive social change by facilitating empowerment of patients and their families in personal goal-directed care and reduction of suffering.

Nursing in the contemporary Australian healthcare system, particularly in speciality areas, is acknowledged as a highly stressful and difficult undertaking. A range of factors has contributed to this situation including changes in staffing levels, patient acuity, resourcing of the healthcare system and nurse recruitment and retention. A number of studies on the intensive care environment have identified factors that cause stress and role strain in nurses. Other research has explored the coping mechanisms these nurses implement to manage work stresses. To date, no Australian studies have sought to provide an encompassing explanation of why and how nurses choose to remain working in this challenging area of practice. This study seeks to develop one possible explanation for this phenomenon. Grounded theory was selected as the most appropriate means of achieving this aim. It explores behavioural patterns and how these develop into interactive social processes. Grounded theory investigates and reveals how people manage problematic life situations, enabling emergence of a substantive theory, which is grounded in context and situation dependent research data. This research study was undertaken in three intensive care units in one area health service in New South Wales. The constant comparative analysis method was used, revealing that nursing in the intensive care environment is a stimulating, challenging experience, which at times is also frustrating and demoralising. The emergent substantive theory was titled “Traversing the path of the intensive care nursing experience”. This study achieves two objectives. It adds to the accumulated knowledge base related to intensive care nursing by offering an explanation of why and how these specialist nurses remain practising at the bedside. It substantiates the results from previous research that investigated stressors and stress management in nursing within the intensive care environment. There are a number of implications for nursing education, research and practice that can be drawn from this study. Impacting on all levels of nursing, these include the development of effective stress management, interpersonal communication techniques, recognition of competence and its assessment, and conflict mediation and management. Further research is needed into understanding nurses’ self-concept and the effect of the working environment on the delivery of effective nursing practice. / Master of Science (Hons.)

Thesis (MCur. (Faculty of Health Sciences))--University of Pretoria, 2006. / Includes bibliographical references.

<p>Forskningen visar att patienter som vårdats på intensivvårdsavdelning har både psykiska och fysiska problem efter utskrivning som kan leda till försämrad livskvalitet. På senare år har detta fenomen uppmärksammats alltmer och uppföljning blir allt vanligare. Vårt syfte var att belysa patienternas erfarenhet av att följas upp efter intensivvård. Metoden var en litteraturstudie där 15 artiklar granskades, bearbetades och analyserades. Resultatet visade att det finns ett behov av uppföljning eftersom patienterna upplevde minnesluckor från intensivvårdsvistelsen eller hade overkliga minnen därifrån och behövde både information och förklaring. Dagboken som skrevs av både närstående och personal under intensivvårdstiden, ansågs som ett vikrigt redskap under återhämtningen. Patienterna uppskattade att ge feedback till personalen och komma med förslag om förändringar som kunde förbättra vården. Mer forskning behövs för att klargöra patienters upplevelse av intensivvården för att utveckla standradvårdplaner och dagboken så att intensivvårspatienten gagnas på bästa sätt.</p>