Spelling suggestions: "subject:"intensive care units"" "subject:"entensive care units""
11 |
The use of the CPAX tool in a South African intensive care unit: clinical outcomes and physiotherapists' perceptionsWhelan, Megan January 2017 (has links)
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Masters of Science in Physiotherapy.
Johannesburg 2017 / Background: There is limited research available on the use of outcome measures in intensive care
units (ICU) in a South African setting.The Chelsea Critical Care Physical Assessment tool (CPAx) is a
measure of morbidity related to physical function and assesses respiratory function and functional
abilities of critically ill patients.
Objectives: The objectives of this study were to establish the effect of the use of the CPAx tool on ICU
and hospital length of stay (LOS) in the care of critically ill patients; to establish the usefulness of the
CPAx tool according to patient admission diagnosis; to determine if a relationship exists between CPAx
scores and severity of illness or general morbidity during ICU admission; and to establish
physiotherapists’ perceptions and views towards the use of the CPAx tool in their daily clinical practice
in ICU.
Design: The study consisted of two parts. Part one was a quasi-experimental design with a historical
matched control group. Part two was a survey-based design.
Methods: The study took place in a South African public sector hospital. Twenty six participants each
were recruited into the experimental and control groups. Participants from the control group were
matched with participants in the experimental group according to age, gender, diagnosis and acute
physiology and chronic health evaluation (APACHE) II scores. CPAx scores and sequential organ failure
assessment (SOFA) scores were calculated for participants in the experimental group on alternate
weekdays during their ICU stay. Comparisons of ICU and hospital LOS between the study participants
and historical control group were done using an independent t-test. Pearson’s correlation coefficient
was used to determine if a relationship existed between CPAx scores, APACHE II scores or SOFA
scores. A p-value ≤ 0.05 was deemed statistically significant. A questionnaire was developed and was
completed by the research assistants who administered the CPAx tool to participants in the experimental
group in order to determine their perceptions of the tool.
Results: The mean age for the CPAx group was 37.88 (±13.37) years and for the control group was
37.81 (±12.21) years. The CPAx group consisted of 14 (53.8%) participants who underwent surgical
procedures and 12 (46.2%) participants with traumatic orthopaedic injuries. The control group consisted
of 14 (53.8%) participants who underwent surgical procedures and 12 (46.2%) participants with
traumatic orthopaedic injuries. The mean initial SOFA score for the CPAx group was 2.42 (±1.79) and
for the control group was 4.15 (±2.6). A p=0.03 indicates that there was a statistically significant
difference between the two groups with regards to initial SOFA scores. The mean SOFA score at ICU
discharge for the CPAx group was 1.80 (±0.42) and for the control group was 2.87 (±1.81). A p=0.05
indicates that there was a statistically significant difference between the two groups with regards to
SOFA scores at ICU discharge.
The mean initial CPAx score for the experimental group was 29.73 points (±14.81) and the mean CPAx
score at ICU discharge was 36.15 (±8.33). The mean CPAx scores changed by 9.45 points between
admission and discharge from ICU for participants who underwent surgical procedures and the mean
CPAx scores changed by 3.9 points between admission and discharge from ICU for participants who
sustained traumatic orthopaedic injuries. The mean ICU LOS for the CPAx group was 5.84 days (±7.43)
and for the control group was 4.56 days (±5.25). The mean hospital LOS for the CPAx group was 17.43
(±16.68) days and for the control group was 19.31 days (±15.79); however, in both cases differences
were not statistically significant.
APACHE II scores had a very weak negative correlation with initial CPAx scores. APACHE II scores
had a very weak positive correlation with CPAx scores at ICU discharge. There was a statistically
significant difference between the two groups with regards to initial SOFA scores (p=0.05). Initial SOFA
scores had a statistically significant moderate negative correlation with initial CPAx scores (r=-0.45,
p=0.02). Initial SOFA scores had a weak negative correlation with CPAx scores at ICU discharge. Initial
CPAx scores had a moderate positive correlation with SOFA scores at ICU discharge. CPAx scores at
ICU discharge had a very strong statistically significant positive correlation with SOFA scores at ICU
discharge (r=0.80, p=0.05).The CPAx tool proved to be more responsive in a surgical population than
in a trauma population. Clinicians had positive perceptions of the CPAx tool in the management of
critically ill patients.
Discussion: Participants in the CPAx group were well matched with those in the historical control group
with regards to age, gender, diagnoses and severity of illness. Those in the CPAx group had lower
extent of organ dysfunction than those in the control group which might account for their shorter period
of hospitalisation. Patients with a higher risk for mortality on admission into the ICU displayed lower
functional abilities and, in turn, lower CPAx scores were measured. A greater change in CPAx scores
was observed for participants recovering from surgical interventions compared to those recovering from
traumatic orthopaedic injuries. Participants with low morbidity at the time of ICU admission seemed to
have a greater ability to perform functional activities during their ICU stay. Limitations of the study
included a small patient sample, a limited number of research assistants as well as lack of content
validation of the questionnaire used. A multi-centre trial on the use of CPAx in ICU patient management
could yield a wider perception of physiotherapists regarding the usefulness of the tool in daily clinical
practice. Measuring the effect of the CPAx tool on participants’ length of mechanical ventilation could
also be an interesting clinical outcome to consider.
Conclusion: The data presented in this study show that the use of the CPAx tool does not have an
influence on ICU and hospital LOS in a small sample of surgical and trauma participants. The tool
appears to be more useful when used in the care of patients who are recovering from surgical
procedures rather than those who sustained complex traumatic injuries. Physiotherapy clinicians that
participated in the study supported the use of the CPAx tool in this single-centre trial and generally had
positive perceptions towards the use of the tool. / MT2017
|
12 |
Planning a pediatric intensive care unit: a nursing viewpointBowden, Marita Silverman, 1944- January 1972 (has links)
No description available.
|
13 |
Die klinische Bedeutung des Nachweises von Enterobacter-Serratia-Spezies auf IntensivstationKrüger, Christiane, January 1980 (has links)
Thesis (doctoral)--Universität Hamburg, 1980.
|
14 |
Developing an integrated information representation for medical intensive care unit patients : generalising work domain analysis /Miller, Anne. January 2004 (has links) (PDF)
Thesis (Ph.D.) - University of Queensland, 2004. / Includes bibliography.
|
15 |
Patients' experiences of machanical ventilation in the intensive care unit of a public sector tertiary hospital in JohannesburgAdeyemi, Ooreofe Bolanle January 2016 (has links)
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, 2016 / Mechanical ventilation is a life-saving and frequently used treatment modality in a variety of
medical diagnosis in the intensive care unit (ICU). Despite that fact, mechanical ventilation
can be a distressing experience for the patient, and may result in anxiety and discomfort. In
recent years, light or no sedation and the practice of wake-up calls have become common
approaches allowing the patient to be more awake during mechanical ventilation. Little is
known about how patients experience this particular aspect of ICU treatment in light of
changes in sedation practices.
This study explored and described the experiences of patients on mechanical ventilation in
the intensive care unit of one public sector hospital in Johannesburg. A qualitative,
descriptive and explorative design was used and ten mechanically ventilated patients were
recruited from the intensive care units of one public sector hospital in Johannesburg. The data
was collected using audio-taped in-depth interviews to keep a record of the actual
information presented by the participants. The collected data was transcribed and the
information was analysed using Clarke and Braun’s (2013) descriptive method.
A general expression from the participants was the fact that being connected to a ventilator
induces a physical and emotional discomfort. The data analysis identified three themes which
were (i) physical experiences, (ii) emotional experiences and (iii) communication.
The participants described their experiences of breathlessness, mouth dryness, pain and
physical discomfort as a result of being placed on the ventilator which caused the physical
experiences for the patients.
The experiences of bothering, fear of unknown, anxiety, feeling shocked and frightened at the
moment of waking up from anaesthesia culminated into an emotional experience for the
patients. The participants described that the extubation process has hard and difficult to
endure, also powerlessness, loss of body image and control and near death experiences were
findings of the participants.
The lack of information was viewed by the participants in terms of being connected to
mechanical ventilation as an important component of the recovery period, the benefit of
purpose of connection during this period and the weaning process although, some of the
participants alluded to receiving a measure of information but described it as inadequate to
prepare them emotionally for the procedure. The short time for visitation and family presence
was also evident in this study as impacting on the emotional state of the participants.
In the midst of these unpleasant experiences, most of the participants appreciated the caring
attitude of the ICU nursing staff which gave them a sense of comfort and safety. The findings
of this study further showed that administration of sedation to some of the participants
affected their memory as they could not recollect things that happen while in the ICU.
Communication was the third theme that emerged from this study as findings revealed that
the participants were not happy with the inability to talk as a result of the endotracheal tube.
Nevertheless, the use of alternative communication methods such as the use of sign language,
writing, scribbling on paper and lip reading gave the participants a bit of a relief.
The findings of this study support the previous findings of the experiences of patients on
mechanical ventilation. The findings add to the body of knowledge from the South African
context as little is known regarding the patients experiences of mechanical ventilation from
the South African context and Africa at large.
As the field of intensive care nursing is growing in the African continent, it becomes
imperative for research to be conducted in order to determine the clinical, educational and
managerial gaps in ICU focusing more on measures to reduce these unpleasant experiences,
increase evidence based practise and nursing perspectives.
It may be appropriate for this study to be replicated in other private and public institution on a
larger scale to compliment these findings. / MT2017
|
16 |
Analysis of the need for additional critical care beds at William Beaumont Hospital--Royal Oak submitted ... in partial fulfillment ... Master of Health Services Administration /O'Donovan, Patrick G. January 1984 (has links)
Thesis (M.H.S.A.)--University of Michigan, 1984.
|
17 |
Analysis of the need for additional critical care beds at William Beaumont Hospital--Royal Oak submitted ... in partial fulfillment ... Master of Health Services Administration /O'Donovan, Patrick G. January 1984 (has links)
Thesis (M.H.S.A.)--University of Michigan, 1984.
|
18 |
A prospective study to investigate the incidence and phenomenology of near-death experiences in a Welsh intensive therapy unitSartori, Penny January 2005 (has links)
No description available.
|
19 |
The opinions of a multidisciplinary team in paediatric intensive care units regarding weaning protocols for mechanical ventilationNjolomole, Abbie N January 2015 (has links)
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.
|
20 |
Intelligent alarms allocating attention among concurrent processes /Huang, Cecil. January 1900 (has links)
Thesis (Ph.D)--Stanford University, 1999. / Title from pdf t.p. (viewed April 3, 2002). "March 1999." "Adminitrivia V1/Prg/19990407"--Metadata.
|
Page generated in 3.4363 seconds