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

No description available.

Thesis (doctoral)--Universität Hamburg, 1980.

Thesis (Ph.D.) - University of Queensland, 2004. / Includes bibliography.

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

Thesis (M.H.S.A.)--University of Michigan, 1984.

Thesis (M.H.S.A.)--University of Michigan, 1984.

No description available.

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.

Thesis (Ph.D)--Stanford University, 1999. / Title from pdf t.p. (viewed April 3, 2002). "March 1999." "Adminitrivia V1/Prg/19990407"--Metadata.