The purpose of this study was to explore and describe nurse-patient communication during critical illness events. The theoretical structure of the study was drawn from communication, sociolinguistic, and nursing theory. Data were collected in a 374-bed private hospital in the Southwest. The sample consisted of six registered nurses and nine patients experiencing cardiac surgery. Nine observed and audiotaped nurse-patient interactions, and fourteen audiotaped partcipant interviews provided the data base for analysis. Content analysis was used to organize the data. Findings were presented in terms of language, paralanguage, and nonverbal expression, and in terms of content, process, and product of nurse-patient communication. Participants used biomedical-technical language and casual-everyday language during the interactions. Nurses talked about what patients would experience while patients talked about themselves as a way of establishing their credibility within the biomedical setting. Nurses viewed nurse-patient communication as variable depending on the patients' needs and responses. Patients viewed nurse-patient communication as straightforward, not requiring adjustment for the needs of the participants. Products of communication for patients involved increased knowledge, reassurance, and increased confidence. Products of communication for nurses involved relieving the patients' anxieties, considering the patients' remembering, and increasing the nursing staff's knowledge about the patient while helping the patient to know the goals of the nursing staff. The introduction and closure segments of the six nurse-patient interactions for preoperative preparation of the patient were analyzed. Nurses began the introductions by assuming that the patients needed relief from anxiety but the patients demonstrated politeness more than anxiety. Nurses used strategies of questioning, starting the physical assessment, topic persistence, and self-monitoring to control the closure segments. Patients used narratives and humor as control strategies. The study findings suggest conceptual areas relevant to nurse-patient communication which may ground theoretical model development for nurse-patient communication. Nurses in clinical settings can compare their patient communication experiences with the findings of the study in order to increase their understanding of expression, form, and function of nurse-patient communication.

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...

D.Cur. / Please refer to full text to view abstract

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.

Thesis (Ph.D.) -- Simmons College, 2009. / Includes bibliographical references (l. 238-247)

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Introduction. MRSA is a major healthcare problem with particular relevance to morbidity and mortality in ICU (Byers & Decker 2008). Due to the increased infection risks associated with cardiac surgery, MRSA screening and surveillance is widely used as a standard preoperative Investigation In many settings (Teoh, Tsim & Yap, 2008). The results, in conjunction with appropriate hygiene precautions, are used to control and prevent infection with MRSA. Following an outbreak of MRSA in cardiac patients an MRSA protocol (MRSAP) was implemented In the cardiac intensive care unit in this study. Purpose. To evaluate how nurses implement the MRSAP in the surgical cardiac intensive care unit in this study, and to evaluate the change in MRSA infection rates following implementation of the MRSAP. From the results obtained, to identify any areas for improvement in nursing practice with respect to the MRSAP. Methods. Nursing staff knowledge with respect to the MRSAP was assessed using a survey questionnaire. Their compliance with required Infection control practice for control of MRSA was assessed through periods of observation on the unit. Screening compliance and reduction in infection rates were investigated using a retrospective records review. Results. The survey revealed good awareness of the MRSAP (88%, n=23), but knowledge of the detailed content was variable. Most staff were apparently satisfied with the existing standards of infection control in CICU (84.6%, n=22). Observation revealed that, compliance with routine hygiene measures was good (66% correct contacts, n=144) by the standard of other studies, but, given the high risk of postoperative infection for these patients improvements are required. Inadequate data in sampled records prevented meaningful analysis of screening compliance, and hence the systems for handling screening swabs and results need to be reviewed. The change in infection rates between the pre and post MRSAP periods, which incorporated use of infection risk stratification data to demonstrate comparability of the two groups of patients, revealed that despite the high MRSA infection rate in 2005 (1.18%), and subsequent drop post MRSAP (0.35%), the actual number of cases found was too small to test statistically for significant difference. An incidental finding was that female cardiac surgery patients were getting significantly younger (p<0.01). There was a significant decrease in hospital MRSA infection rates for matched periods (p<0.0001 ). Conclusions. Evidence was found to support the efficacy of the MRSAP in the reduction of MRSA infections. Deficits in staff knowledge and infection control practice were identified and feedback has been implemented in order to improve compliance with the MRSAP and maintain the improved infection rates. Further research with respect to implementation of, and compliance with, infection control measures could both improve quality of patient care and decrease the burden of preventable infectious disease such as health care associated infections (HAls) in South Africa. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2008.

The purpose of this study was to examine burnout in the critical care nurse. One hundred-eighty eight nurses employed at Community Hospitals of Indiana were surveyed to determine the relationship between burnout, level of expertise and social support systems. Frequency and intensity of burnout was measured by the Maslach Burnout Inventory. Social support systems were measured by the Norbeck Social Support Questionnaire. Level of expertise was determined by question 1 of the demographic questionnaire length of time employed as a critical care nurse.Findings of this study revealed no significant differences in level of expertise related to intensity and frequency of burnout (F= .232). Results of ANOVA indicated the sampled nurses experienced a low to average degree of burnout for both frequency and intensity of burnout. Similarly using Pearson correlate there was no relationship between level of support systems and frequency also concluded that level of support systems did not and intensity of burnout (novice, p= -.23; competent, p= .11; expert, p= .07). Conclusions of this study indicated level of expertise was not a factor in determining intensity and frequency of burnout.It was burnout need to be readily available for all nurses in influence intensity and frequency of burnout in the novice, competent or expert critical care nurse.Implications indicate that preventative measures for critical care settings. Other implications were that nursing support systems may not be an effective strategy for burnout prevention and resources may need to focus on other strategies. / School of Nursing

Caring is a universal need of all humans and is central to the practice of nursing (Watson, 1979). Considerable research has been conducted in the study of caring behavior and caring. However, there has been little nursing research which focuses on the meaning of care as perceived by the patient. The purpose of this study was to further determine the patient's perceptions of caring behaviors of nurses by using Watson's (1979) theory of carative nursing.Watson's theory identified ten carative factors which served as the basis for the caring behavior's assessment instrument's (CBA) seven subscales. The instrument was administered to a convenience sample of 100 adults, 59% female, 40% male over 21 years of age hospitalized during 1997-1998 on the progressive care unit of a large Midwest hospital.Data were analyzed using descriptive and correlational statistics as well as MANOVA. The Cronbach's alpha reliability coefficient for each subscale ranged from 0.88 to 0.98. Principle components factor analysis revealed seven factors which accounted for 71% of the variance in the data and provided support for construct validity of the instrument.Finding showed that critical care patients perceived caring behaviors of nurses in a critical care setting as having much importance on all seven subscales of the CBA. Overall, they perceived technical professional, helping/ trusting subscale and teaching/learning subscale as having much importance. There were no significant differences found on behaviors based on age, sex, education, length of hospital stay and number of hospital admissions.There were no significant differences between those who were married and not married. Married patients perceived as less caring behavior on humanism helping/trusting and teaching subscales.A major conclusion was that patients in the critical care setting overall perceived all behaviors of nurses in a critical care setting as identified in the CBA's seven subscales of the instrument as having the most importance. The behaviors identified as having the most important were technical-professional including giving shots and taking care of equipment (monitor). / School of Nursing