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

Thesis (M.Nurs.)--University of Hong Kong, 2008. / Includes bibliographical references (p. 78-89)

Thesis (M.S.)--Ohio State University. / Includes bibliographical references (leaves 70-73). Available online via OhioLINK's ETD Center

Proefschrift Rijksuniversiteit Groningen. / Datum laatste controle: 22-12-1997. Met lit.opg. en samenvatting in het Nederlands.

The author of the work-related psychological problems of patients in intensive care, which leads to reduced quality of life.

Professional nurses working in an intensive care unit (ICU) are faced with the death of critically ill patients frequently. Modern day medicine and technology have made it possible for advanced life-sustaining measures to be implemented on patients who, without medical intervention, would otherwise not have survived. The question is raised: is modern technology preserving life and prolonging the dying process, or is it in the best interest of the patient for treatment to be withdrawn? Nurses, caring for these patients and their families, are practicing at the bedside of these dying patients and are thus often faced with end-of-life issues, particularly withdrawal of treatment. The primary functions of critical care nurses are toward their patients. Physicians are responsible for making decisions regarding withdrawal of treatment. However, the nurses in the ICU are responsible for implementing the decisions made; sometimes contradicting what they believe in. The experience of end-of-life issues, namely withdrawal of treatment, is a cause of distress for the professional nurse. Little research has been done on how the ICU nurses deal with end-of-life issues and what support structures are required to assist nurses in dealing with end-of-life issues (Hov, Hedelin & Athlin, 2006:204) The objectives of the study were to explore and describe the professional nurses‟ lived experiences of end-of-life issues in the intensive care unit. The study aimed to make recommendations regarding support strategies to assist professional nurses in dealing with end-of-life issues in the intensive care unit. The researcher has selected a qualitative research approach with an explorative, descriptive and contextual design in order to conduct the study. Data was collected by means of semi-structured interviews. Data was analysed using the steps as illustrated by Tesch‟s method. Ethical principles were maintained throughout the research study. The findings of this study are to be presented in a journal publication.

Introduction - Gastrointestinal tonometry has been widely used in adult practice for the early detection of shock and multi-organ failure. Its application in paediatrics has been limited by unsuitably large tonometers and doubt about the accuracy of measurements when saline is used as a tonometric fluid / vehicle for carbon dioxide (CO₂) equilibration. Objective - To evaluate the accuracy and reliability of the newly developed saline 5 French (5F) neonatal gastric tonometer. Study Design - (a) Direct in-vivo comparison of the 5F 0.9%saline tonometer (NST) with the recirculating gas tonometer (RGT) [the current reference standard in adult practice] in 10 Paediatric intensive care unit (PICU) patients, measuring tonometric PCO₂ (PtCO₂) and gastric intramucosal PCO₂ (PiCO₂). (b) In-vivo comparison of PiCO₂ measurements from two 5F tonometers in 10 PICU patients in unfed and fed state. (c) In-vitro comparison of reference PCO₂ to PtCO₂ values obtained using 0.9%saline and phosphate buffered saline in SF tonometers, and the RGT. Results - (a) Comparing the SF NST to RGT in 50 paired simultaneous measurements over PtCO₂ range 3.0 - 9.7kPa, the mean bias was -1.44kPa; limits of agreements (LOA) ±1.45kPa. The mean values of PtCO₂- derived gastric intramucosal pH (pHi) and PiCO₂-PaCO₂ difference differed significantly by -.11 and + 1.1kPa respectively (p<0.0001). (b) 100 paired 5F NST measurements (50 fed/ 50 unfed) over PtCO₂ range 2.48-11.1kPa were assessed. No significant difference was observed in PtCO₂: mean difference (standard deviation) - unfed 0.05kPa (0.36) (p=0.36); fed 0.05kPa (0.42) (p=0.43). (c) 20 consecutive measurements of PtCO₂ were obtained from the 5F NST, 5F phosphate buffered saline tonometer (PBST) and RGT at constant reference PCOi's of 2.5, 5.0, 7.5, 10.0kPa. The 5F NST underestimated the reference PCO₂ by a mean bias of 58% (LOA ±20%); the 5F PBST by 6% (LOA ±26%); while the RGT performed best with a mean bias of 5.7% and tight LOA ±1.5%. Conclusion - There are inherent problems in the methodology of the saline tonometry utilised in the 5F neonatal gastric tonometer. The use of the saline SF neonatal gastric tonometer to monitor gut perfusion in neonates and children should be interpreted with caution. Recirculating gas tonometry is the most accurate method of tonometry studied.

M.Cur. / The South African Nursing Act (Act 50 of 1978) views the professional nurse as an independent practitioner, her independent function being the right to make decisions and taking the full responsibility for such liability. The professional nurse's liability depends on her authority, skills and responsibilities. Her role in the intensive care unit is aimed at optimal care of the ventilated patient, thus providing physical, psychological and spiritual well-being. The incidence of micro-organism colonization in the lower airway of the ventilated patient is researched in this study and nursing guide-lines are set out for the correct use of the ventilator. A contextual, descriptive study was carried out to: (a) determine the sterility of the humidifier reservoir and ventilator tubes; (b) determine which micro-organisms are present in the lower airways of patients after they have been ventilated; (c) set out guide-lines for the nursing staff on how to correctly use the ventilator. Sample analysis was done from the following: The sterile water in the reservoir prior to ventilation. Sputum obtained prior to extubation. Water from the reservoir after extubation (waterbasin of the humidifier). The water present in the ventilator tubes after extubation. The following conclusions were made: contamination is caused by the nursing staff; there was no migration of micro-organisms from the water reservoir to the circuit; the organisms in the ventilator circuit differed from those found in the lower airways of the patient...

M.Cur / To be able to nurse effectively in a critical care unit, a nurse needs to have extensive theoretical knowledge, excellent clinical skills and a certain degree of technological knowledge. The Diploma in Critical Care offered at higher educational institutions, in collaboration with private/public health delivery institutions within South Africa, aims to equip nurses with the necessary knowledge and clinical skills they need to work in this stressful and complex environment. Learners found that during the programme for the Diploma in Critical Care they were faced with a large amount of stress and demotivation due to reasons such as not being treated like an adult, the increased workload and the demands of the theoretical and clinical programmes. Some learners were faced with theoretical and clinical challenges and felt that they needed to be prepared for academic work at a higher educational institution, some found that they experienced emotional stress due to a lack of knowledge and the responsibility of being delegated to nurse critically ill patients. If a learner is unable to succeed in the programme the first time there are financial implications for the learner, the higher educational institution and the health delivery institution. It was previously thought that prior experience in a critical care unit was sufficient preparation to succeed in the critical care programme, but not all learners are exposed to the same learning opportunities prior to commencing with the programme and therefore learners do not enter the programme with the same knowledge base. There are also various factors that influence the learner during the programme. A private health group in Gauteng implemented the successful completion of a clinical skills workbook as part of the requirements for learners registering for the Diploma in Critical Care. The workbook focuses on the attainment of basic clinical skills that are required to be able to work in a critical care unit and not on basic theoretical knowledge. In view of the above it remains unclear whether the clinical skills workbook implemented by a specific private health care group is sufficient preparation for a learner prior to commencing with the critical care programme. The aim of this study is to determine whether the completion of a critical care pre-programme study guide will make a significant difference in the success of learners from a private health group in Gauteng who register for the Diploma in Critical Care at a specific higher educational institution. To achieve this goal the following objectives were stated: 1. Develop a pre-programme study guide. 2. Implement the pre-programme study guide. 3. Determine if the completion of a critical care pre-programme study guide makes a significant difference to the success of learners from a specific private health care delivery group during the Diploma in Medical & Surgical Nursing Science: Critical Care Nursing (General). To achieve the goal of the study, a quantitative, quasi-experimental and correlational design will be used. The study will be divided into two phases: phase one will involve the development of a pre-programme study guide for the critical care programme, based on a literature review. Phase two will include the implementation of the pre-programme study guide, and the research methodology for this phase will be an untreated control group with a pre-test and post-test. The pre-programme study guide made a significant difference to the cores of the experimental group in terms of the pre-test and pot-test scores, whilst the control groups scores neither improved nor deteriorated. There was no significant difference between the experimental and control group in terms of the pre-test, post-test, semester marks and exam marks. This could be due to the large standard of deviations that were obtained. The null hypothesis was accepted. The completion of the pre-programme study guide can be used as part of the requirements for learners registering for the Diploma in Critical Care and can help alleviate the stress and demotivation experienced by the learners during the Diploma in Critical Care.

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