Thesis (M.S.)--University of Michigan, 1978.

Thesis (Ph. D.)--University of Texas at Austin, 2004. / Supervisor: Angela P. Clark. Vita. Includes bibliographical references.

Thesis (Ph.D.)--Duquesne University, 2006. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p.117-123) and index.

Patients who are critically ill get often admitted to intensive care units (ICUs). The majority of these patients require support with their breathing and are thus connected to a mechanical ventilator. One aspect to consider in the mechanically ventilated patient is endotracheal tube cuff pressure (ETT) management. The management of ETT cuff pressure entails that nurses working in ICUs have the responsibility of ensuring that ETT cuff pressure is kept within normal range of 20-30 cmH20 for the safety of the patients in order to avoid complication of over and under inflation. Poor management of ETT cuff pressure places the mechanically ventilated patients under risk of tracheal injury. Tracheal injury may also be caused by over or under inflation of the ETT cuff. Over inflation of the ETT cuff can lead to the occlusion of capillaries lining the trachea at the cuff site, tracheal stenosis, and can also lead to the death of mucus membranes around the area, just to mention a few. On the other hand, under inflation of the ETT cuff, can lead to air leaks as well as aspiration of gastric contents into the tracheal tree. Therefore, in order to maintain ETT cuff pressure within normal ranges, evidence-based guidelines related to the management of ETT cuff pressure should be used. However, in Malawi the management of endotracheal tube cuff pressure in mechanically ventilated adult patients by nurses in ICUs is not well explored and it is not clear whether this practice is based on evidence-based guidelines. Furthermore, strategies on how to implement evidence-based guidelines in the ICU might not be known and poorly defined because of the complexity of the context. The study is therefore aimed at implementing and evaluating the effect of an evidence-based guideline on the management of ETT cuff pressure in mechanically ventilated adult patients by nurses in ICUs in Malawi using active (printed educational materials and monitoring visits) and passive (printed educational materials only) implementation strategies. The research study used a quantitative approach with multi-designs. Four phases were used in order to achieve the four objectives that were set. Phase one was the pre-test and used a survey design, two was the expert panel review of the evidence-based guideline, three was the implementation of the reviewed evidence-based guideline using a randomised controlled trial design and phase four was the post-test which used a survey design. The RCT included 25 participants from the control and 27 from the intervention group. Each group had three ICUs of which one in each group was from a private hospital and the other were government. Data collection in phases one and four was by a hand delivered pre-and post-questionnaire. In phase two the expert panel members with experience in critical care used the AGREE II Instrument to review the evidence-based guideline that was implemented. In order to gather data during the monitoring visits, the researcher recorded field notes. The applications that were developed by the University statistician consultant using visual basic applications in excel were used to analyse data. Two different implementation strategies were used to implement the evidence-based guideline. The control group used passive implementation strategy which was printed educational materials thus the evidence-based guideline and algorithm. The intervention group used both active and passive implementation strategies which was the printed educational materials thus the evidence-based guideline and algorithm plus monitoring visits by the researcher. In order to establish the effect of the implemented evidence-based guideline on the nursing care practice for the management of endotracheal tube cuff pressure an evaluative posttest survey was conducted in phase four of the research study. The results revealed that the majority of participants had gaps in both groups regarding nursing care practice for the management of endotracheal tube cuff pressure for the mechanically ventilated adult patients in the pretest but improved in the posttest. In the control group 52% had very low knowledge score, 16% had low score, 28% average, and 4% high score while in the category of very high score there was nobody. However, in the posttest those in the very low score were only 44% while the percentage in the low score remained 16%. There was an improvement in the average scores in the posttest such that only 44% were in this category. There was no one in the high and very high score in the pretest. On the other hand, in the intervention group, 78% had a very low score, 9% low score, and 13% were in the category of average score, while in the high and very high score category there was zero percent in the pretest. However, there was also an improvement in the posttest such that only 44% a very low knowledge score. But 19% had a low score, there were 37% in the average category and no one was in the high and very high score. Statistical analysis revealed that the results were not significantly different between and within groups. Improvements were observed in the two groups regarding the scientific knowledge scores for the nursing care practices in the posttest. Upon qualitative analysis of the data from the open-ended question, two main themes emerged thus the need for documentation of endotracheal tube cuff and the process of implementation the evidence-based guidelines. Sub themes such as lack of documentation; no part of routine care and monitoring not done at all were identified under the main theme of the need for documentation of ETT cuff pressure. The Guideline itself need to be clear; implementation strategies; follow up; incentives; supervision; incentives; time factor; resources or equipment required for successful implementation; nurses buy-in critical for the implementation; training detrimental to EBP implementation; nurses attitude crucial to implementation of EBGs and knowledge of nurses for guideline essential for the implementation were the sub themes identified under the main theme of the process of implementing the evidence-based guideline. All appropriate ethical considerations such as principles of autonomy and self-determination, confidentiality and anonymity, voluntary participation, right to receive treatment, informed consent, were adhered to throughout the research study. The research study was unique in nature because it was the first of its kind in Malawi and it contributed to the awareness of the recommended practice for management of endotracheal tube cuff pressure in the ICUs in the country by implementing an evidence-based guideline. The unique contribution of the study is that it is a challenge to implement evidence-based guideline in poor and resource constraint countries like Malawi.

M.Cur. / In the cardiothoracic critical care unit, the respiratory management, post-extubation forms an important component of the total nursing care of the patient. To ensure optimal respiratory management the critical care nurse needs guidelines through which quality and continuity of nursing care can be ensured. Through the effective management of the respiratory system of the patient the critical care nurse contributes to maintaining, promoting and restoring health. In this way the critical care nurse facilitates the patient's strive towards reaching his/her objective of obtaining wholeness and he/she obtains his/her objective of quality nursing. The aim of this study is to formulate guidelines for the respiratory mangement of the cardiothoracic patient, post-extubation. A qualitative-descriptive contextual spesific reseach was followed in which a focus group interview, the opinions of field specialists and the deductive analysis of a literture study were used to formulate guidelines for the respiratory management of the cardiothoracic patient, post-extubation. An analysis was done through which the focus group interview was coded and categories were formulated. These main categories and subcategories were then further explored and described by the literature and by die opinions of the field specialists. The guidelines which were formulated must relieve the uncertainty that exists among different critical care nurses and it must ensure continuity of nursing care. After the guideliness have been established to promote the nursing practice recommendations were made for nursing practice, nursing education and for further research.

Purpose: The purpose of this project was to conduct an educational workshop among ICU nurses working in rural areas, to reduce risk of compassion fatigue. Background: Compassion fatigue is a job-related hazard unique to professionals in caring professions such as nursing. Rural ICU nurses represent a population that may encounter unique triggers for the risk of compassion fatigue due to professional isolation, less resources and more risk of knowing the patient as a community member. A review of literature reveals limited research related to compassion fatigue development in rural ICU nurses. Method: Two educational workshops were conducted among rural ICU nurses (N=3). Workshop content included discussion about symptoms, triggers, and outcomes of compassion fatigue, as well as positive coping strategies. Participants journaled physical and emotional responses to situations such as ethical or moral dilemmas, boundary issues, and aspects of self-care. Each workshop included time to discuss the educational content and participant experiences; the resulting narratives were analyzed for commonalities. Findings: Universally, burnout was viewed as inherent to the profession. All participants recounted past traumatic patient encounters that preoccupies their thinking when in similar situations. Symptoms identified as compassion fatigue included chronic, constant, generalized pain, symptoms of depression, isolation, withdrawal and lack of interest in enjoyable activities. Triggers were prolonged patient hospitalizations due to lack of resources, lack of supporting services, lack of leadership support, unexpected patient loss, witnessing patient trauma and grief, caring for patients who did not seem to really need ICU, social situations surrounding patients 10 and floating to different departments. Increased alcohol intake, sarcasm, and venting were the most reported mitigation strategies among participants. Implications: Compassion fatigue negatively impacts the lives of rural ICU nurses on many dimensions, although it is perceived as inherent to the profession. These participants desired support from nursing leadership and a supportive work environment. Participants expressed they continued to feel compassion, despite experiencing the phenomenon described as compassion fatigue. A less stigmatizing term might better capture the phenomenon now labeled as compassion fatigue.

No description available.

M.Cur. / From out the researchers experience of the critical care nursing practice, a need for clinical learning outcomes was identified. There are no listed guidelines or outcomes of what the critical care learner should be able to do at the end of the program, to function as a competent critical care-nursing practitioner. From the above mentioned problemstatement the following question were asked namely: Which knowledge's, skills, attitudes and values do the critical care learner need to function as a compatend critical care nursing practitioner? The main aim of this study was to compile a manual with clinical learning outcomes for the following disciplines within the critical care practice + Cardiology and cardio-thorasic surgery + General surgery and Pulmonary + Neuro-surgery and trauma From out the constructivistic learning approach a contextual, qualitative and describing study was done.The first objective namely the formulation of clinical learning outcomes from out the literature was done by means of a extensive literature survey. The second and third objective of the study namely the formulation of clinical learning outcomes for the different disciplines within the critical care practices. And compiling a manual for the preceptor in the critical care practice was done simultaneously. The clinical learning outcomes was written directly into the format of a manual. Eighty questioners was handed out to critical care trained registered nurses. The data gathered from out the questioners was used in identifying learning outcomes. There are generic clinical learning outcomes, these outcomes are universal for al the disciplines within the critical care practice. Specific clinical learning outcomes where identified for • Coronary and thoracic surgery • Neuro-surgery and • Trauma Specific learning outcomes are outcomes that are only applicable within that specific discipline. If effective clinical guidance are facilitated by means of the clinical learning outcomes and the learner has reached al the outcomes, he/she should be able to function as a competend critical nursing practitioner.

M.Cur. / The cardiothoracic intensive care unit is a dynamic environment which is characterised by a high patient turnover, staff shortages, medication, doctor's and nursing protocols and specialised nursing skills are required of the registered nurse. The registered nurse working in this environment is an independent practitioner and is accountable for her acts and omissions. The registered nurse can only accept accountability if she/he has the ability (knowledge, skills and values), the responsibility and authority to carry out the actions (Bergman, 1982:8). The learner enters the cardiothoracic intensive care unit as part of the clinical teaching she receives at a specific university. Due to staff shortages, the learner is often given the responsibility and authority to carry out actions for which she is accountable, without having the ability (knowledge, skills and values) to act. She may, therefore, not be able to nurse the patient safely and effectively. The unit manager is responsible for creating a learning climate in the unit and utilises an orientation programme to create this climate. An orientation programme introduces new staff members to the philosophy, goals and procedures necessary to work in a particular setting (Brookfield, 1986:64). The adult learner wants to learn that which is task- and problem-orientated in a selfdirective, independent way ida climate that is conducive to learning. The question arises: What must the content of an orientation programme for a certain cardiothoracic intensive care unit of a specific private hospital be and how must it be managed to facilitate safe and effective nursing by learners working in the cardiothoracic intensive care unit? The objective of the study is to explore and describe the content and management of an orientation programme for a specific cardiothoracic intensive care unit in a specific private hospital. A qualitative, exploratory and descriptive contextual study was conducted to explore and describe the content and management of the orientation programme. A contextual framework is described and focus group interviews were conducted with learners and registered nurses. From the results of the conceptual framework and focus group interviews, the content and manageent of the orientation programme was described. Due to the function perspective of the study, an orientatio nprogramme was developed from the results of the study.

M.Cur. (Nursing Science) / The primary objective of this study was to determine the emotional intelligence (EI) of, and make recommendations to facilitate an improvement in the EI of professional nurses commencing work in critical care units in private hospitals in Gauteng, South Africa. The quality of nursing care directly affects patient outcomes such as morbidity, mortality, adverse events as well as the total cost of care. This places the nurse central in good, comprehensive health care, especially in the critical care environment. Professional nurses starting in critical care consistently experience feelings of anxiety regarding their performance, related to the intensity of patient care, insufficient knowledge, extreme workload, role uncertainty, the feeling of being unsafe, making mistakes, having to work with new technology, as well as social acceptance in critical care with its unique working culture. Emotional labour is a big part of critical care, which leads us to explore emotional intelligence. Emotional intelligence (EI) is the ability to monitor one’s own and others’ feelings, to discriminate among them, and to use this information to guide one’s thinking and actions. It also refers to the ability to identify, express, understand and regulate emotions. Though emotional skills are learnt during childhood, it can also be developed and changed later in life with age, experience and good role models or mentors. Nurses with a higher EI have more positive attitudes, greater adaptability, improved relationships, and increased orientation towards positive values. The question that arose was: what is the emotional intelligence of professional nurses starting in critical care for the first time?...