Thesis (MCur)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: The critical care nurse works in an environment where patient need often shifts the parameters within which she or he practices. It is expected of a skilled critical care nurse to be able to make independent decisions and take action regarding patient care based on her or his knowledge and skills without discounting the parameters of her or his scope of practice. Practice experience has indicated that the critical care nurse is often uncertain about whether her or his clinical activities are protected by the regulations provided by the Nursing Council. This is more specifically true in the private hospital industry where medical advice or assistance is not always easily available. This situation led to the following research question: Do the available professional and legal guidelines provide an appropriate foundation to guide the practice of the registered critical care nurse in the private hospital sector critical care environment? A non-experimental descriptive study with a qualitative orientation was conducted in 19 private hospitals in the Western Cape. Through nonprobability, random sampling, 71 registered critical care nurses were included in the study. A questionnaire was designed and validated to collect the data. Quantitative data was analysed through Excel® while qualitative data was analysed thematically. It was found that the legal and professional guidelines in place at present do provide a foundation for the clinical activities of critical care nursing in the private hospital sector. It is suggested that it is rather the critical care nurses’ interpretation of the Scope of Practice (No.R.2598 of 30/11/1984 as amended) that limits their practice as opposed to the wording of the regulations. It is recommended that critical care nurses must determine nursing care parameters based on patient need, using the regulations as a foundation for critical, analytical and reflective practice rather than as a set of rules to be followed. Key words: Scope of practice, critical care practice, ICU nursing care, private hospital nursing practice. / AFRIKAANSE OPSOMMING: Die kritiekesorgverpleegkundige werk in ‘n omgewing waar pasiëntebehoeftes gereeld die parameters waarin sy of hy praktiseer, verskuif. Dit word van ’n bekwame kritiekesorgverpleegkundige verwag dat sy of hy onafhanklike besluite en aksies met betrekking tot pasiëntesorg, gebaseer op haar of sy kennis en vaardighede, sal neem sonder om die parameters van haar of sy bestek van praktyk te oorskry. Praktykondervinding het getoon dat die kritiekesorgverpleegkundige dikwels onseker is oor watter van haar of sy optredes deur die Regulasies, soos deur die Raad op Verpleging gespesifiseer word, beskerm word. Dit is nog meer spesifiek van toepassing in die privaathospitaal-industrie waar geneeskundige advies en bystand nie altyd maklik beskikbaar is nie. Die situasie het tot die volgende navorsingsvraag aanleiding gegee: Voorsien die beskikbare professionele en wetlike riglyne ’n geskikte grondslag om die praktyk van ’n geregistreerde kritiekesorgverpleegkundige in die privaatsektor- kritiekesorgomgewing te rig? ’n Nie-eksperimentele, beskrywende studie met ’n kwalitatiewe oriëntasie is in 19 hospitale in die Wes-Kaap onderneem. Deur nie-waarskynlikheids-, toevallige steekproefneming is 71 geregistreerde kritiekesorgverpleegkundiges in die studie ingesluit. ’n Vraelys is ontwerp en gevalideer om inligting in te samel. Kwantitatiewe data is deur middel van Excel ontleed terwyl kwalitatiewe data tematies ontleed is. Daar is gevind dat die wetlike en professionele riglyne wat tans beskikbaar is, ‘n grondslag bied vir die kliniese aktiwiteite van kritiekesorgverpleegkundiges in die privaathospitaal.. Dit word voorgestel dat dit die kritiekesorgverpleegkundige se interpretasie van die Bestek van Praktyk (No.R.2598 of 30/11/1984 soos aangepas) is wat hulle praktyk beperk, eerder as die bewoording van die regulasie self.

Introduction: The thesis "Alzheimer's disease and department of intensive care" deals with the specifics and difficulties of nursing care for patients with this chronic and degenerative disease in intensive care units (ICUs). The number of patients with Alzheimer's disease is constantly growing and caring for them in such specific wards is extremely demanding. The purpose of this thesis was to map the most problematic areas in the care provided and propose their solution. Methods and results: The empirical part presents the results of a conducted qualitative research which took place in the form of interviews with 10 general nurses who have experience with such patients. Following a word-for-word transcription of the obtained interviews, the results are summarized in a final discussion. They show that when caring for a patient with dementia, general nurses see the main problems in his decreased ability to cooperate, behavioral changes, which often appear as a result of environment change, and difficult communication. They consider the patient's confusion, his negativism, and the inability to find the right words to be communication barriers. This results in enormous demands on the caring staff's patience. The interviewed general nurses however approach patients with dementia generally positively...

O objetivo deste estudo foi avaliar a aplicação do Nursing Activities Score – NAS – como instrumento para medir carga de trabalho de enfermagem em UTI de cirurgia cardíaca, verificando sua correlação com escores de estratificação de risco e gravidade, comparar o quadro de enfermagem existente na UTI com o projetado segundo o instrumento NAS, e comparar o escore NAS atribuído ao paciente por avaliação das necessidades de cuidado (prospectiva) com a avaliação feita a partir dos cuidados efetuados. Trata-se de um estudo de desenvolvimento metodológico de avaliação de um instrumento de medida de carga de trabalho em UTI, que foi realizado em uma UTI de cirurgia cardíaca com 65 leitos ativados, localizada em hospital público de ensino, especializado em cardiologia na cidade de São Paulo. Participaram do estudo 100 pacientes submetidos à Revascularização do Miocárdio, Tratamento Cirúrgico das Válvulas Cardíacas ou ambos, no mês de outubro de 2005. Todos foram avaliados pelo Escore de risco cirúrgico de Parsonnet, pelo índice de gravidade Simplified Acute Physiology Score II - SAPS II - e submetidos à aplicação diária do instrumento de medida de carga de trabalho de enfermagem NAS. A análise dos dados mostrou que 66% dos pacientes eram do sexo masculino, tinham a idade mínima de 17, máxima de 89 e média de 57,72 (±14,78) anos e que 60% foram submetidos à Revascularização do Miocárdio, 29% à Tratamento Cirúrgico das Válvulas Cardíacas e 11% a ambos os procedimentos. Com relação ao risco cirúrgico, 62% dos pacientes apresentaram um escore de Parsonnet acima de 10 e risco cirúrgico maior que 2%, o SAPS II médio foi de 25,81(±10,68), mínimo de 6 e máximo de 70, e risco de morte médio de 10,65%. A média de permanência desses pacientes na UTI foi de 5,62 dias e a taxa de óbito de 10%. O NAS foi aplicado 682 vezes, sendo que a média da pontuação total durante a permanência na UTI foi de 485,22 e a média da pontuação diária foi de 74,62 (±9,16) o que corresponde a 18,24 horas de assistência de enfermagem por dia. Para o pós-operatório imediato obteve-se em média 96,79 pontos, para o primeiro pós-operatório, 63,82 pontos e para o segundo pós-operatório, 65,72 que correspondem a 23,22 horas de assistência para o POI, 15,31 horas para o 1º P.O. e 15,77 horas para o 2º P.O, considerando que cada ponto NAS correnponde a 14,4 minutos. As análises estatísticas mostraram correlação significantes (P<0,001) entre o NAS Total, o SAPS II, e o Escore de Parsonnet. Dos 15.686 itens pontuados, 285 (1,81%) foram alterados com dados da avaliação retrospectiva indicando a possibilidade de aplicação de forma prospectiva do instrumento. / The aim of this study was to evaluate the application of the Nursing Activities Score – NAS – as an instrument to measure the nursing workload in a Cardiac Surgery Intensive Care Unit (ICU), verifying it’s correlation with risk stratification and severity scores, compare the real ICU nursing staff with the NAS nursing staff projection, and compare the NAS score of the patient’s care necessities evaluation (prospective) with the evaluation done after proper medical care. This research consists in the methodological development and evaluation of a measurement workload tool in the ICU, and it was developed in a Cardiac Surgery ICU with sixty five active beds, in a public cardiology teaching hospital in São Paulo city. 100 patients took part in the study by undergoing Miocardial Revascularization, Surgical Treatment of the Cardiac Valves or both, in the month of October, 2005. The patients were evaluated by the Parsonnet’s surgical risk score and by the Simplified Acute Physiologic Score II – SAPS II – severity score, they were also submitted to the daily application of the nursing workload measurement tool, NAS. The data analysis revealed that 66% of the patients were male with minimum age of 17 and maximum age of 89, averaging 57,72 (±14,78) years; 60% underwent Miocardial Revascularization, 29% underwent surgical treatment of the cardiac valves and 11% endured both procedures. In regards the cardiologic risk, 62% of the patients presented the Parsonnet score higher then 10 and the surgical risk above 2%, the average SAPS II was 25,81 (+/- 10,68), minimum 6 and maximum 70, and the probability of death was 10,65%. The length of stay in the ICU was 5,62 days and the death rate was 10%. The NAS was applied 682 times; the average NAS during the whole Intensive Care Unit stay – total NAS – was 485,22 (+/- 861,78) and the average daily NAS was 74,62 (+/- 9,16), equivalent to 18,24 hours of daily nursing assistance. The immediate post-op counted 96,79 points, while the first post-op 63,2 points and the second post-op 65,72 points, meaning 23,22 hours of assistance for the I.P.O., 15,31 hours for the 1st P.O. and 15,77 for the 2nd P.O., considering each NAS point as 14,4 minutes. Statistical analysis showed significant correlation (P<0,001) between the total NAS, the SAPS II and the Parsonnet’s score. From the 15.686 NAS items evaluated, 285 (1,81%) were modified, indicating the possibility of prospective application of NAS.

Thesis advisor: Pamela J. Grace / Nurses working in newborn intensive care units (NICU) report experiencing ethical dilemmas related to treatment decisions for infants in their care. The opportunity for nurses to contribute to the formulation of treatment plans for these infants is increasing, but often nurses are required to implement treatment plans with which they may not agree. This causes conflict for the nurse and has been shown to have implications for the nurse and, ultimately, nursing and healthcare practice. Not taking action to resolve the perceived dilemma is especially problematic on several counts (Raines, 1996). Nurse Activism, the outcome variable, is defined as the range of likely actions nurses may take to resolve ethical dilemmas in practice (Penticuff & Walden, 1987). This cross-sectional study investigated the range of likely actions that nurses would take in response to a hypothetical ethical dilemma. The web-based survey was completed by 224 NICU nurses from seven Massachusetts hospitals. Subjects responded to the Nurses Ethical Involvement Survey (Penticuff & Walden, 1987) and demographic questions. Hierarchical multiple regression analysis found that NICU nurses with greater concern for the ethical aspects of clinical practice (p = .001) and an increased perception of their ability to influence ethical decision-making (p = .018) were more likely to exhibit nurse activism to resolve an ethical dilemma and these findings explained just 8.5 percent of the variance. Future research is necessary to determine other factors contributing to, and inhibiting the actions of, nurses to resolve ethical dilemmas encountered in the NICU. / Thesis (PhD) — Boston College, 2010. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Background Instillation of nonnal saline before suctioning is a common nursing intervention although little research supports the practice. Objectives To detennine when and how often saline is used during suctioning and to assess the knowledge of nurses and respiratory therapists of the advantages and dangers of using saline during endotracheal suctioning. Methods A survey of nurses and respiratory therapists working in adult and neonatal intensive care units was conducted in three large teaching hospitals in the UAE. Results Of the 81 respondents, 38 (47%) rarely instil saline before suctioning, whereas 20 (25%) frequently use saline. Seventy-four percent use saline to enhance retrieval of secretions, and 72% use it to stimulate cough. Nurses and respiratory therapists differ in their use and understanding of saline instillation. Most nurses (56%) rarely use saline before suctioning, whereas most respiratory therapists (37%) frequently use saline. Respiratory therapists (93%) were more aware than were nurses (61%) of the benefit of using nonnal saline to stimulate a cough. Respiratory therapists considered oxygen desaturation as a major adverse effect of saline instillation in comparison to nurses who stressed on pulmonary infection as a major side effect. Conclusion The results of the survey indicates that the practice of these professionals are not in line with most recent research results in the area and indicate a need for in-service education. / Thesis (M.Cur.)-University of Natal,Durban, 2002.

Background: Comprehensive oral care is an evidence-based, cost effective, essential routine nursing intervention that nurses ought to provide with good knowledge/understanding as it prevents and controls nosocomial infections especially Ventilator Associated Pneumonia (VAP) that is associated with increased morbidity and mortality in critically ill patients in Intensive Care Units (ICU). Aim of study: To determine ICU nurses’ knowledge, describe their practices and identify their perceptions regarding comprehensive oral health care to critically ill patients in order to refine or develop evidence based oral care protocol. Methods: A quantitative approach with a descriptive, exploratory survey was used for this study. A non probability convenience sample of thirty-four (34) ICU nurses from two public referral hospitals participated in this study. A questionnaire with a combination of open and closed ended questions was used to collect data on comprehensive oral care to critically ill patients. Results Thirty-four nurses responded to the questionnaire (response rate 89%). Only 18% (n=6) were knowledgeable about important aspects of oral care, while the majority, 82% (n=28) lacked knowledge on important aspects of oral care. Fifty-nine percent (59%) n=20 had received training on comprehensive oral care at basic nursing training and 44% (n=15) had orientation at unit level. Ninety-seven percent (97%) n=33 of the participants requested further updates on comprehensive oral care. No significant relationships were found between nurses’ demographic characteristics and knowledge of comprehensive oral care. All (100%) n=34 of nurses gave oral care a high priority and 91% ranked it very important for critically ill patients. Toothbrushes and toothpaste were used by 85% (n=29) of nurses and only 50% (n=17) used mouthwashes. The reason for non- use of mouthwashes was lack of supplies and not having been foreseen in unit protocol although neither of the units had an oral care protocol in place. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.

Burnout is reflected in pathological emotional depletion and maladaptive detachment that is a secondary result of exposure prolonged occupational stress. It is comprised of three dimensions, namely, emotional exhaustion, depersonalization and reduced personal accomplishment. It is becoming increasingly recognized as one of the most serious occupational hazards for nurses who work in critical care units. The objectives of this study are to assess the prevalence of burnout among a sample of nurses who worked in the critical care units in a particular hospital in Kenya, to analyze factors that contributed to the development of burnout and to identify measures for the mitigation of burnout. For this study, the researcher utilized a mixed methods research design in two phases. Phase one assessed the prevalence of burnout in nurses working in the critical care units by making use of the Maslach Burnout Inventory – Human Services Survey. Focus groups discussions were then held in Phase two to investigate the factors that the nurses perceived as the main causes of burnout and to solicit their ideas about it could be mitigated. Convenience sampling and purposive sampling were used in the two phases of the study respectively. / Health Studies / M.A. (Health Studies)

The purpose of this study was to explore and describe the knowledge that a cohort of 40 intensive care unit nurses had of evidence-based practice. It was assumed that they lacked the knowledge to locate, evaluate understand and apply research findings. Quantitative, non-experimental descriptive research was conducted to explore their knowledge and to formulate recommendations for promoting it. Data collection involved administering a structured questionnaire administered to the cohort in an intensive care unit. The findings revealed that, although they were familiar with the basic concept of evidence-based practice, they were reluctant and lacked the skills to adopt it in their practice. It is recommended that they be trained and empowered to develop research expertise from within their own ranks. Finally it is recommended that nursing management should play a more proactive role in identifying cost-effective strategies in overcoming barriers to finding, promoting and integrating evidence-based practice / Health Studies / M.A. (Health Studies)

O objetivo deste estudo foi avaliar a aplicação do Nursing Activities Score – NAS – como instrumento para medir carga de trabalho de enfermagem em UTI de cirurgia cardíaca, verificando sua correlação com escores de estratificação de risco e gravidade, comparar o quadro de enfermagem existente na UTI com o projetado segundo o instrumento NAS, e comparar o escore NAS atribuído ao paciente por avaliação das necessidades de cuidado (prospectiva) com a avaliação feita a partir dos cuidados efetuados. Trata-se de um estudo de desenvolvimento metodológico de avaliação de um instrumento de medida de carga de trabalho em UTI, que foi realizado em uma UTI de cirurgia cardíaca com 65 leitos ativados, localizada em hospital público de ensino, especializado em cardiologia na cidade de São Paulo. Participaram do estudo 100 pacientes submetidos à Revascularização do Miocárdio, Tratamento Cirúrgico das Válvulas Cardíacas ou ambos, no mês de outubro de 2005. Todos foram avaliados pelo Escore de risco cirúrgico de Parsonnet, pelo índice de gravidade Simplified Acute Physiology Score II - SAPS II - e submetidos à aplicação diária do instrumento de medida de carga de trabalho de enfermagem NAS. A análise dos dados mostrou que 66% dos pacientes eram do sexo masculino, tinham a idade mínima de 17, máxima de 89 e média de 57,72 (±14,78) anos e que 60% foram submetidos à Revascularização do Miocárdio, 29% à Tratamento Cirúrgico das Válvulas Cardíacas e 11% a ambos os procedimentos. Com relação ao risco cirúrgico, 62% dos pacientes apresentaram um escore de Parsonnet acima de 10 e risco cirúrgico maior que 2%, o SAPS II médio foi de 25,81(±10,68), mínimo de 6 e máximo de 70, e risco de morte médio de 10,65%. A média de permanência desses pacientes na UTI foi de 5,62 dias e a taxa de óbito de 10%. O NAS foi aplicado 682 vezes, sendo que a média da pontuação total durante a permanência na UTI foi de 485,22 e a média da pontuação diária foi de 74,62 (±9,16) o que corresponde a 18,24 horas de assistência de enfermagem por dia. Para o pós-operatório imediato obteve-se em média 96,79 pontos, para o primeiro pós-operatório, 63,82 pontos e para o segundo pós-operatório, 65,72 que correspondem a 23,22 horas de assistência para o POI, 15,31 horas para o 1º P.O. e 15,77 horas para o 2º P.O, considerando que cada ponto NAS correnponde a 14,4 minutos. As análises estatísticas mostraram correlação significantes (P<0,001) entre o NAS Total, o SAPS II, e o Escore de Parsonnet. Dos 15.686 itens pontuados, 285 (1,81%) foram alterados com dados da avaliação retrospectiva indicando a possibilidade de aplicação de forma prospectiva do instrumento. / The aim of this study was to evaluate the application of the Nursing Activities Score – NAS – as an instrument to measure the nursing workload in a Cardiac Surgery Intensive Care Unit (ICU), verifying it’s correlation with risk stratification and severity scores, compare the real ICU nursing staff with the NAS nursing staff projection, and compare the NAS score of the patient’s care necessities evaluation (prospective) with the evaluation done after proper medical care. This research consists in the methodological development and evaluation of a measurement workload tool in the ICU, and it was developed in a Cardiac Surgery ICU with sixty five active beds, in a public cardiology teaching hospital in São Paulo city. 100 patients took part in the study by undergoing Miocardial Revascularization, Surgical Treatment of the Cardiac Valves or both, in the month of October, 2005. The patients were evaluated by the Parsonnet’s surgical risk score and by the Simplified Acute Physiologic Score II – SAPS II – severity score, they were also submitted to the daily application of the nursing workload measurement tool, NAS. The data analysis revealed that 66% of the patients were male with minimum age of 17 and maximum age of 89, averaging 57,72 (±14,78) years; 60% underwent Miocardial Revascularization, 29% underwent surgical treatment of the cardiac valves and 11% endured both procedures. In regards the cardiologic risk, 62% of the patients presented the Parsonnet score higher then 10 and the surgical risk above 2%, the average SAPS II was 25,81 (+/- 10,68), minimum 6 and maximum 70, and the probability of death was 10,65%. The length of stay in the ICU was 5,62 days and the death rate was 10%. The NAS was applied 682 times; the average NAS during the whole Intensive Care Unit stay – total NAS – was 485,22 (+/- 861,78) and the average daily NAS was 74,62 (+/- 9,16), equivalent to 18,24 hours of daily nursing assistance. The immediate post-op counted 96,79 points, while the first post-op 63,2 points and the second post-op 65,72 points, meaning 23,22 hours of assistance for the I.P.O., 15,31 hours for the 1st P.O. and 15,77 for the 2nd P.O., considering each NAS point as 14,4 minutes. Statistical analysis showed significant correlation (P<0,001) between the total NAS, the SAPS II and the Parsonnet’s score. From the 15.686 NAS items evaluated, 285 (1,81%) were modified, indicating the possibility of prospective application of NAS.

M.Cur. / The study started by establishing that there Is a need for further education for nurses in general. It'was further stated that due to increased technology and the need for patient care, effective further education becomes a priority. But the problem that remains Is how nurses could further their education In the circumstances of the current nature of their work, I.e. the lack of accessibility to flexible learning programmes, long working hours, staff shortfall, low staff morale and institutional constraints. The aim of this study Is to Investigate and report on the Web-based Instruction environment programme in Critical Care Nursing Science Education presented by Technikon Pretoria for nurses. The rationale led to .the formulation of the research question as: "To what extent can Web-based Instruction be used to facilitate a course in Critical Care Nursing Science Education at the Technikon Pretoria?" A literature review of the field of Web-based Instruction was undertaken. It was established that Web-based Instruction is an instructional strategy where the course presenter and the students are not in contact, and it can bridge the gap in tenns of time and space because of its flexibility and accessibility. The students and the course presenter generally reported positive experiences in the Web-based Instruction environment. Web-based Instruction is certainly not the only method for.all our teaching strategies, but it is a strategy that could be used tohelp course presenters to teach more effectively. In terms of the experiences of the students and the course presenter with regard to the Web-based Instruction environment as reported in this study, as well as the technological changes In education. it must be concluded that Web-based Instruction could be considered an acceptable Instructional method and that Critical Care Nursing Science education can be presented in this way...