Proefschrift Universiteit Maastricht. / Met bibliogr., lit. opg. - Met samenvatting in het Nederlands.

Proefschrift Universiteit Maastricht. / Met lit. opg. - Met samenvatting in het Nederlands.

M.Cur. / The intensive care nurse practising respiratory nursing care, is responsible for giving high quality nursing care. Due to the rising cost of health care more pressure is placed on the nurse to provide a high quality nursing care (Sanazaro, 1986:27) Bruwer (1986:220-245) states that there is a need for an orderly, methodical qua l Ity assurance approach on all nursing levels in South Africa, based on a South African model, as well as the development of nursing standards for public and private hospitals. Mechanical ventilation forms an important part of the nursing of the adult critically ill patient in the intensive care unit. To ensure that the patient benefits from mechanical ventilation and does not suffer from complications due to mechanical ventilation, standards must be developed to ensure the giving of a high quality of nursing care. Without these standards it is impossible to determine the quality of their nursing care given. The quality can furthermore,only be questioned and not be determined scientifically. Standards for providing high quality nursing care to mechanically ventilated patients do not exist in South Africa. The quality of the nursing care that these patients receive is therefore questioned.

M.Cur. (Intensive Care Nursing) / The nurse working in an intensive care unit is legally accountable for complete and accurate record-keeping. Record-keeping is especially important during a crisis incident as the sequential management or treatment depends on what happened before and during the crisis incident. Before she can be held accountable for complete and accurate record-keeping, the nurse must have the necessary abilities (knowledge, skills and values) . She will have to accept the responsibility and legally she will receive the authority for it. Complete and accurate record-keeping helps to maintain, improve and restore the critical patient's health. In this way the nurse working in an intensive care unit facilitates the patient's aim for wholeness and at the same time achieves her own aim for' quality nursing. The purpose of this research is accurate nursing records are kept intensive care unit. A contextual-descriptive research design, including a survey method and retrospective auditing were used to determine the completeness and accuracy of record-keeping by nurses during a crisis incident. Auditing was done on the basis of three structured control lists. The results showed that the graphic-symbolic report was more complete and accurate with regard to the patients' particulars and graphic accuracy. The results also showed that there is a great variance in the knowledge and skills of the nurses working in the intensive care unit, regarding record-keeping. Recommendations evolving from this study are: The purpose and use of the records should be clarified. The record system must be revised. Temporary staff must be accompanied on day duty by permanent staff members before they start working night duty. The allocation of the staff must be revised. A policy for record-keeping must be established. In-service training for expanding knowledge regarding record- keeping must be initiated. The purpose and the use of record-keeping must be included in the orientation program. Records must be evaluated to identify shortcomings.

Bakgrund: Överrapporteringen är ett kritiskt moment i patientens vårdkedja. Vid överrapportering från operation till den postoperativa avdelningen är det därför viktigt att det sker på ett strukturerat och inarbetat sätt. Bristande kommunikation mellan vårdpersonal har visat sig vara en vanlig orsak till vårdrelaterade skador. För att kunna bedriva en säker och högkvalitativ vård krävs en god kommunikation och ett fungerande samarbete mellan vårdpersonal. Syfte:Syftet var att beskriva anestesisjuksköterskors upplevelser av hur vårdmiljön påverkar överrapporteringen på en postoperativ avdelning. Metod:Studien genomfördes med en kvalitativ ansats. Individuella intervjuer genomfördes med åtta deltagare. Data analyserades med kvalitativ innehållsanalys med manifest ansats. Resultat: Analysen resulterade i tre kategorier: Att bli avbruten och störd; Att sekretessen och patientens integritet äventyras och Att avskildhet, struktur och planering är avgörande. Anestesisjuksköterskor beskrev att dem upplevde en hög arbetsbelastning, hög ljudnivå och att den fysiska vårdmiljön påverkar överrapporteringen negativt. Dem värnade om patienternas integritet och sekretess men beskrevatt den fysiska vårdmiljön som kännetecknas av öppna ytor, samt brist på avskärmning påverkar patientens integritet och sekretess negativt. I resultatet framkom att anestesisjuksköterskor ansåg att det finns behov av förbättring av den fysiska miljön och efterfrågade ett avskärmat utrymme där överrapporteringen kan ske ostört. Konklusion: En konklusion av denna studies resultat är att utformningen av vårdmiljön på en postoperativ avdelning tillsammans med en hög ljudnivå och arbetsbelastning utgör hinder för en god och patientsäker överrapportering mellan enheterna. Anestesisjuksköterskor värnar om patientens integritet och säkerhet, men identifierar hinder för detta och ger förslag på förbättringar av vårdmiljön som skapar förutsättningar för en god och säker överrapportering. Anestesisjuksköterskor bör göras delaktiga i förbättringsarbeten kring överrapporteringar lokalt på vårdenheter.

The definition of awareness used consistently in this thesis is: Explicit recall of intraoperative events during general anaesthesia. Since there is no objective method to detect awareness, the patients must be interviewed after anaesthesia. The form and timing of the interview is crucial. To rely on spontaneous disclosure of awareness episodes is not sufficient. The total number of awareness-victims is considerable although the incidence may seem modest. A number of these patients look upon the awareness experience as the worst experience in their life. Suffering can include pain, mental distress and delayed psychological symptoms. However, the experience of awareness is not uniform and not all patients suffer. A comprehensible definition for dreaming during anaesthesia is: Any recalled experience, excluding awareness, which occurred between induction of anaesthesia and the first moment of consciousness upon emergence. Some findings point in the direction that dreaming during anaesthesia may be related to light or insufficient anaesthesia, but other findings do not. Some patients find dreaming during anaesthesia distressing, but generally the overall impression is that consequences of dreaming during anaesthesia seem to be small and of minor importance to the majority of patients. In this thesis I have found the following:The incidence of awareness is approximately 0.2% when neuromuscular blocking drugs are used and awareness also exists without these drugs, albeit to a lesser extent. These findings represent standard practice in an adult population at normal risk. 50% of awareness cases may have delayed recall of awareness. Using a consecutive inclusion design we found initial awareness suffering comparable to previous studies, but a lower incidence and less pronounced severity of late psychological symptoms. The incidences found among the awareness-victims in our study were; experience of pain 46%, immediate mental distress 65%, any late psychological symptom 33%, and PTSD below 10%. A memory of an intraoperative dream after general anaesthesia is not an early interpretation of delayed awareness, indicating that no routine follow up of dreaming-only patients is indicated. Dreams reported after anesthesia are generally not related to insufficient anesthesia defined as high BIS, and should not be regarded as near awareness.

Critical care nursing is a clinical specialist nursing practice discipline. The critical care nurse provides a constant presence in the care of a critically ill patient. She/he creates a thread of continuity in care through the myriad of other health care professionals and activities that form part of a patient’s stay in the critical care environment (World Federation of Critical Care Nurses [WFCCN], 2007). During conversations with people who have had intimate experience of the critical care environment, they have offered anecdotes that describe their interaction with critical care nurses who they perceive to be different from and better than other critical care nurses they encountered. Despite having met common professional requirements to be registered as a clinical specialist nurse, these distinctive, unique abilities that seem to be influential in meeting the complex needs and expectations of critically ill patients, their significant others as well as nursing and medical colleagues, are not displayed by all critical care nurses. While students of accredited postgraduate nursing programmes are required to advance their nursing knowledge and skill competence, many students do not seem to develop other, perhaps more tacit, qualities that utilisers characterise in their anecdotes of ‘different and better’ nursing practice. The overarching research question guiding this study was how can ‘different and better’ critical care nursing practice as recognised by a utiliser be explained? The purpose of this study was to develop an understanding of the qualities that those people who use critical care nursing practice recognise as ‘different and better’ to the norm of nursing practice they encounter in this discipline. The participant sample included patients’ significant others, nursing colleagues and medical colleagues of critical care nurses, collectively identified as utilisers. The stated aim of this work was to construct a grounded theory to elucidate an understanding of the qualities that a utiliser of critical care nursing recognises as ‘different and better’ critical care nursing practice in order to enhance the teaching and learning encounters between nurse educators and postgraduate students in learning programmes aiming to develop clinical specialist nurses. The method processes of grounded theory are designed to reveal and confirm concepts from within the data as well as the connections between these concepts, supporting the researcher in crafting a substantive theory that is definitively grounded in the participants’ views and stories (Streubert & Carpenter, 2011: 123, 128-129). Two data collection tools were employed in this study, namely in-depth unstructured individual interviews and naïve sketch. Constant comparative analysis, memo-writing, theoretical sampling, theoretical sensitivity and theoretical saturation as fundamental methods of data generation in grounded theory were applied. The study unfolded through three broad parts, namely: Forming & shaping this grounded theory through exploration and co-creation; Assimilating & situating this grounded theory through understanding and enfolding; Reflecting on this grounded theory through contemplating and reconnecting. The outcome of the first part of the study was my initial proposition of a grounded theory co-created in the interactions between the participants and myself. This was then challenged, developed and assimilated through a focussed literature review through the second part of the study. Through these two parts of this study, an inductively derived explanation was formed and shaped to produce an assimilated and situated substantive grounded theory named Being at Ease. This grounded theory articulates how ‘better and different’ nursing is recognised from the point of view of those who use the nursing ability of critical care nurses through the core concern ‘being at ease’ and its four categories ‘knowing self’, ‘skilled being’, connecting with intention’ and’ anchoring’. The final part of this study unfolded in my reflections on what this grounded theory had revealed about nurses and elements of nursing practice that are important to a utiliser in recognising ‘different and better’ critical care nursing. I suggest that as nurses we need to develop a language that enables us to reveal with clarity these intangible and tacit elements recognised within the being and doing of ‘different and better’ nursing. I reflected on the pivotal space of influence a teacher has with a student, and on how the elements essential in being and doing ‘different and better’ nursing need to be evident in her/his own ways of being a teacher of nursing. Teaching and learning encounters may be enhanced through drawing what this theory has shown as necessary elements that shape ‘different and better’ nurses through the moments of influence a teacher has in each encounter with a student.

No description available.

This study describes the meaning intensive care unit nurses attach to their care of the brain dead patient. A phenomenological methodology was used because of its intent to understand experience as it is lived. Because these patients constitute a unique class of dead patients which require intensive nursing care and because of the scarcity of information available on the subjective experience of nurses who provide this care, the study was considered to be essential to fillful a gap in our knowledge. Data were collected through 28 interviews with 11 Caucasian female participants who work in the intensive care units of a tertiary and a quaternary care hospital within the greater Vancouver area. Their ages ranged from their early twenties to over forty years of age. They represented five religious demoninations with one participant having no religious affiliations. One nurse had cared for between two and five brain dead patients, four had provided care for six to ten brain dead patients, and six had cared for more than ten brain dead patients. Throughout the participants' accounts dissonance was the pervasive and unifying theme. The dissonance was seen in the form of either personal or interpersonal discord. The former was seen in relation to five areas: the participant's philosophy about nursing, traditional nursing care activities, the concept of brain death, organ retrieval and transplantation, and professional responsibilities in relation to meeting the nurse's own emotional needs. In contrast, the latter occurred between the nurse and families, physicians, the Pacific Organ Retrieval for Transplantation Team and nursing colleagues. Either form of dissonance results in personal distress and subsequent attempts to reduce the dissonance by distancing and/or designating another as the target of nursing care. / Applied Science, Faculty of / Nursing, School of / Graduate

Bakgrund: Patienter som genomgår generell anestesi uttrycker oro och ångest inför att bli sövda. Anestesisjuksköterskor beskriver likaså att det är vanligt förekommande med perioperativ ångest hos patienter i samband med kirurgi. Anestesisjuksköterskan betonar vikten av god kommunikation för att lindra ångest och främja patienternas välbefinnande. Syfte: Syftet är att beskriva patienters upplevelser av att genomgå regional anestesi. Metod: Kvalitativ litteraturstudie som innefattar analys av 20 vårdvetenskapliga artiklar. Resultat: Patienterna upplevde diverse känslofenomen som exempelvis smärta, obehag och känselbortfall. Patienterna belyser vikten av att känna sig delaktiga i deras egen vård. Detta främjades utav anestesisjuksköterskornas fysiska närvaro och emotionella stöd. God information ansågs vara en förutsättning för att patienterna skulle känna sig trygga. I de fall där patienterna kände att information var bristfällig kände de istället sig utsatta. Slutsats: Upplevelsen kan uppfattas både som negativ och positiv. Negativ i form av att anestesin kan uppfattas som smärtsam samt förlust av kontroll, rörlighet och känsla av utsatthet. En förutsättning för att främja delaktighet och trygghet hos patienterna är att som anestesisjuksköterska kunna etablera en vårdande relation. Kunskap kring patienternas utsatta situation, behovet av närhet, kontakt och kontinuerlig information är avgörande för att utföra en god omvårdnad för att främja välbefinnande och hälsa. / Background: Patients undergoing general anesthesia expresses a strong concern and anxiety about being anesthetized. The nurse anaesthetist also describe the prevalence of perioperative anxiety in patients in connection with surgery. The nurse anaesthetist emphasizes the importance of good communication to alleviate anxiety and promote patients' well-being. Purpose: The purpose of this study is to describe patients' experiences of undergoing regional anesthesia. Method: Qualitative literature study that includes analysis of 20 caring science articles. Results: Patients experienced various emotional phenomena such as pain, discomfort and loss of sensation. Patients highlight the importance of feeling involved in their own care. This was promoted by the physical presence and emotional support of the nurse anaesthetist. Good information was considered a prerequisite for patients to feel safe. In cases where patients felt that information was deficient, they instead felt exposed. Conclusion: The experience of undergoing regional anesthesia can be perceived as both negative and positive. A prerequisite for promoting participation and safety in patients is that as a nurse anaesthetist be able to establish a caring relationship. Knowledge of the patients' vulnerable situation, the need for closeness, contact and continuous information is crucial to carry out good nursing to promote well-being and health.