Thesis (MEd (Curriculum Studies)--University of Stellenbosch, 2005. / Ventilator-associated infections contribute to most of the fatal infections in the intensive care. Considerable intensive care resources are also consumed in the treatment of ventilatorassociated infections. Not only economic costs, but also expenditure of staff energies, physical resources, treatment expenses and admission to the intensive care contribute to the complexity of the problem. Despite the large progress in medical treatment over the past decades, the incidence and case fatality rates of health-care-associated ventilator-associated infections remain high. Patients who require mechanical ventilation have a particularly high risk of healthcare- associated infections. Ventilator-associated infections have been a major complication for years, but the researcher has found that no formal attempts, except for inclusion of the concept as part of critical care nursing curricula, have been made to educate nurses with regard to the active prevention of ventilator-associated infections in adult patients. There are also limited data available regarding infection control education-based interventions targeting healthcare systems, e.g. intensive care units. The research goal was to establish and evaluate a learning programme for nurses caring for adult patients with ventilator-associated infections (Learning Programme). This took place in two Australian hospitals during 2003 and 2004. The objectives of the research were divided into three phases. Evidenced-based literature on the above concepts was utilised by the researcher and deductively implemented and validated by a focus (specialist) group to develop the Learning Programme in Phase One.

No description available.

Critical care nurses work in an environment rich in informative interactions. Although there have been post hoc self-report survey studies of nurses' information seeking, there have been no observational studies of the patterns and content of their on-duty information behavior. This study used participant observation and in-context interviews to describe 50 hours of the observable information behavior of a representative sample of critical care nurses in a 20-bed critical care hospital unit. The researcher used open, in vivo, and axial coding to develop a grounded theory model of their consistent pattern of multimedia interactions. The resulting Nurse's Patient-Chart Cycle describes nurses' activities during the shift as centering on a regular alternation with the patient and the patient's chart (various record systems), clearly bounded with nursing "report" interactions at the beginning and the end of the shift. The nurses' demeanor markedly changed between interactions with the chart and interactions with the patient. Other informative interactions were observed with other health care workers and the patient's family, friends and visitors. The nurses' information seeking was centered on the patient. They mostly sought information from people, the patient record and other digital systems. They acted on or passed on most of the information they found. Some information they recorded for their personal use during the shift. The researcher observed the nurses using mostly patient specific information, but they also used some social and logistic information. They occasionally sought knowledge based information. Barriers to information acquisition included illegible handwriting, difficult navigation of online systems, equipment failure, unavailable people, social protocols and mistakes caused by multi-tasking people working with multiple complex systems. No formal use was observed of standardized nursing diagnoses, nursing interventions, or nursing outcomes taxonomies. While the nurses expressed respect for evidence-based practice, there clearly was no time or opportunity for reading research literature (either on paper or online) while on duty. All participants expressed frustration with the amount of redundant data entry required of them. The results of this study have significant implications for the design of clinical information systems and library services for working critical care nurses.

Submitted in fulfillment of the requirements for the Degree in Master of Health Sciences in Nursing, Durban University of Technology, Durban, South Africa, 2016. / Introduction Moral distress is a widely recorded phenomenon in the nursing profession. It can be described as a form of distress that occurs when one knows the ethically correct thing to do, but is prevented from acting on that perceived obligation. Moral distress impacts patients, nurses and the organization. If the nurse is unable to advocate for her or his patient and avoidance behaviour occurs, increased patient suffering result. Moral distress results in high staff turnover, decreased quality patient care and low patient satisfaction. Unrelieved moral distress jeopardizes nurse’s sense of self-worth and threatens their integrity. Aim of the study The aim of the study was to determine the impact of moral distress on the provision of nursing care amongst critical care nurses. Methodology A quantitative descriptive design was used to determine the intensity and frequency of moral distress amongst critical care nurses, to assess the impact of moral distress on the provision of nursing care to the patient as well as to evaluate the effectiveness of organisational strategies implemented to reduce moral distress. Critical care nurses from both private and public hospitals were selected to participate in the study. Data was collected by means of a survey using the moral distress scale which was revised to meet the objectives of the study. A non-probability purposive sampling technique was utilised to gather data from a sample size of 100 critical care nurses currently working in the critical care environment. Results The study indicates that the frequency and intensity of moral distress is related to specific clinical situations in the critical care environment. The study also specifies that moral distress continues to have a negative effect on the provision of nursing care. Critical care nurses feel that some strategies are effective whereas others are not at all effective. Impact of the research study This study reveals that there is a significant negative effect of moral distress on the provision of nursing care. Nurses experience challenges in the clinical environment that result in them experiencing moral distress. Nurses more attuned to the ethical dimensions of care may be more at risk for moral distress since these nurses see the moral dimensions of nursing being neglected. Nurses may find themselves distancing themselves from patient care, resulting in a perceived lack of care and concern for the patient. / M

patients and their families. The purpose of the study was firstly, to explore and interpret the meaning of the experiences of critical care nursing students about clinical accompaniment in open distance learning (ODL). This aspect has not been researched before and as such, there is no empirical data about the clinical accompaniment of the critical care-nursing students in ODL. Secondly, to develop guidelines for facilitation of clinical accompaniment in critical care nursing in ODL. A qualitative hermeneutic phenomenological study was conducted. Non-probability purposive sampling was used to select participants to provide information about clinical accompaniment in ODL. Data was obtained through in-depth interviews supplemented by field notes compiled during fieldwork. The study findings revealed that participants regard relationships and communication as important for clinical accompaniment. The distance factor inherent in distance learning was problematic for student’s motivation and support. The presence and visibility of the lecturer was pivotal for the students. Of importance also were the relationships with the managers and colleagues. The perception of participants was that managers of clinical facilities were not as readily accessible as would have been the lecturer. Although negative experiences were described, paradoxically these experiences seemed to have empowered the student to develop survival skills, patience and assertiveness to take action on how to deal with the situation. From the findings the researcher was able to develop guidelines the implementation of which, is hoped to ensure effective clinical accompaniment of critical care nursing students in ODL. / Health Studies / D. Litt. et Phil. (Health Studies)

Att vårdas i respirator innebär att den verbala kommunikationsförmågan förloras, vilket kan medföra känslor av frustration och maktlöshet hos patienter. För att uppnå en vårdande relation är samtalet av stor betydelse, vilket försvåras om kommunikationsförmågan är nedsatt. Syftet är att beskriva intensivvårdssjuksköterskors upplevelser av kommunikation med lätt sederade, respiratorbehandlade patienter. En kvalitativ ansats har använts. Halvstrukturerade forskningsintervjuer utfördes med åtta intensivvårdssjuksköterskor från två sjukhus. En kvalitativ innehållsanalys användes för att analysera materialet, vilket resulterade i två kategorier med tre subkategorier vardera. Intensivvårdssjuksköterskors upplevelser av kommunikation med lätt sederade respiratorbehandlade patienter beskrivs som att finnas där och att nå fram. Genom att finnas där bjuder intensivvårdssjuksköterskor in patienter, erhåller känslomässiga gensvar samt förmedlar budskap genom sitt kroppsspråk och sin personlighet. För att nå fram måste intensivvårdssjuksköterskor skapa gynnsamma förhållanden för kommunikation och hitta ett gemensamt språk med patienter, vilket är beroende av både intensivvårdssjuksköterskans och patientens bagage. Intensivvårdssjuksköterskors egna kroppar är centrala i kommunikationen med dessa patienter. Kroppsspråk och beröring används för att bekräfta intensivvårdssjuksköterskors närvaro, förmedla närhet och trygghet samt för att utveckla en vårdande relation till patienter. Att lära sig läsa patienter, då de responderar ljudlöst, är en annan stor del av kommunikationen. Även här är kroppen central, då intensivvårdssjuksköterskors förmåga att läsa patienters kroppar och dess signaler är väsentligt för att nå fram, vilket underlättas av att lära känna patienten. Erfarenhet och utbildning kan medföra att intensivvårdssjuksköterskor känner trygghet i sig själva, vilket bidrar till att de har modet att finnas där hos patienter och därmed utveckla en vårdande relation. / Program: Specialistsjuksköterskeutbildning med inriktning mot intensivvård

For cardiac surgical patients, the immediate 2-hour recovery period is distinguished by potentially life-threatening haemodynamic instability. To ensure optimum patient outcomes, nurses of varying levels of experience must make rapid and accurate decisions in response to episodes of haemodynamic instability. Decision complexity, nurses’ characteristics, and environmental characteristics, have each been found to influence nurses' decision making in some form. However, the effect of the interplay between these influences on decision outcomes has not been investigated. The aim of the research reported in this thesis was to explore variability in critical care nurses' haemodynamic decision making as a function of interplay between haemodynamic decision complexity, nurses' experience, and specific environmental characteristics by applying a naturalistic decision making design. Thirty-eight nurses were observed recovering patients in the immediate 2-hour period after cardiac surgery. A follow-up semi-structured interview was conducted. A naturalistic decision making approach was used. An organising framework for the goals of therapy related to maintaining haemodynamic stability after cardiac surgery was developed to assist the observation and analysis of practice. The three goals of therapy were the optimisation of cardiovascular performance, the promotion of haemostasia, and the reestablishment of normothermia. The research was conducted in two phases. Phase One explored issues related to observation as method, and identified emergent themes. Phase Two incorporated findings of Phase 1, investigating the variability in nurses' haemodynamic decision making in relation to the three goals of therapy. The findings showed that patients had a high acuity after cardiac surgery and suffered numerous episodes of haemodynamic instability during the immediate 2-hour recovery period. The quality of nurses' decision making in relation to the three goals of therapy was influenced by the experience of the nurse and social interactions with colleagues. Experienced nurses demonstrated decision making that reflected the ability to recognise subtle changes in haemodynamic cues, integrate complex combinations of cues, and respond rapidly to instability. The quality of inexperienced nurses' decision making varied according to the level and form of decision support as well as the complexity of the task. When assistance was provided by nursing colleagues during the reception and recovery of patients, the characteristics of team decision making were observed. Team decision making in this context was categorised as either integrated or non integrated. Team decision making influenced nurses' emotions and actions and decision making practices. Findings revealed nurses' experience affected interactions with other team members and their perceptions of assuming responsibility for complex patients. Interplay between decision complexity, nurses' experience, and the environment in which decisions were made influenced the quality of nurses' decision making and created an environment of team decision making, which, in turn, influenced nurses' emotional responses and practice outcomes. The observed variability in haemodynamic decision making has implications for nurse education, nursing practice, and system processes regarding patient allocation and clinical supervision.

Includes bibliographical references. / 1 v. (various paging) : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (D.Nurs.)--University of Adelaide, Dept. of Clinical Nursing, 2002

The purpose of this thesis was to examine the relationship between locus of control and the intensive care nurse's perception of job-related situations. It was hypothesized that intensive care nurses who evidenced an external locus of control would classify job-related situations as more stressful, more threatening, and less challenging than intensive care nurses who evidenced an internal locus of control. The instruments consisted of (1) a demographic questionnaire, (2) an instrument developed by this investigator to measure the degree of perceived stressful, threatening, and challenging aspects of certain job-related situations, and (3) Rotter's Internal-External Locus of Control Scale. The questionnaires were distributed to nurses working in intensive and coronary care units in one medium sized city in Indiana. An N of 75 was obtained.The hypotheses that external intensive care nurses would classify job-related situations as more stressful and more threatening were supported (F = 9.26, p<0.01, and F = 6.08, p<0.01 respectively). The hypothesis that internal nurses would classify more job-related situations as challenging was not supported by the data (F = 0.01, p = 0,91).Ball State UniversityMuncie, IN 47306

published_or_final_version / Nursing Studies / Master / Master of Nursing