Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 5 uppsatser.

Thesis (Ph. D.)--Virginia Commonwealth University, 2010. / Prepared for: School of Nursing. Title from title-page of electronic thesis. Bibliography: leaves 80-85.

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

Evidenced based practice (EBP) guidelines have been developed to reduce variation in weaning, provide quality of care and patient satisfaction. Nurse led weaning has been shown to reduce weaning time, and therefore it was important to identify whether nurses have sufficient knowledge to implement EBP regarding weaning (Hansen, Fjaelberg, Nilsen et al, 2008);(Crocker, 2002:272). Weaning protocols are associated with 25.0% reduction in the duration of mechanical ventilation time, a 78.0% reduction in weaning duration, and 10.0% reduction for length of stay in ICU (Blackwood, Alderdice, Burns et al, 2011:9). The purpose of the study was to evaluate and describe intensive care nurses’ knowledge of EBP guidelines with regard to weaning the mechanically ventilated patient. Five adult intensive care units at two tertiary public sector academic hospitals were used to conduct the study in order to determine barriers to EBP. A non-experimental, descriptive, prospective two-staged design was utilized in this two part study. In Stage I of the study, the sample size comprised six (n=6) specialist expert members selected from the ICU’s at the study site using a non-probability purposive sampling method. In Stage II of the study, the sample size comprised eighty (n=80) intensive care nurse respondents selected from the ICU’s using simple random sampling. The data collection instrument developed by the researcher comprised 40 items relevant to nursing practice derived from EBP weaning guidelines. Respondents were asked to rate all the items independently using a 4-point Likert scale. Findings indicated that intensive care nurses lack adequate knowledge on weaning the critically ill patient from the mechanical ventilator. The Dreyfuss model of skill acquisition shows that improved skill performance in nursing is based on experience as well as education, yet this study showed the opposite (Dracup & Bryan-Brown, 2004). Years of experience did not influence nurses’ knowledge level, as there was no statistical difference in these items. Differences in knowledge scores between the primary nurse and shift leaders were minimal, although significant (p<0.05), indicating that shift leaders were more knowledgeable than primary nurses.

Mechanical ventilation (MV) is the defining event of intensive care unit (ICU) management. Although it is a lifesaving intervention in patients with acute respiratory failure and other diseases, a major goal of critical care clinicians should be to liberate patients from MV as early as possible to avoid the multitude of complications and risks associated with prolonged MV. Such complications include an increase in mortality, morbidity and ICU length of stay (LOS), as well as reduced functional status and quality of life (Moodie et al 2011; Gosselink et al 2008). Rapid weaning however has its own potential problems such as fatigue or cardiovascular instability, either of which may ultimately delay the weaning process. Premature extubation, leading to reintubation, is associated with increased risk of pneumonia and mortality (Brown et al 2011; Meade et al 2001 (a)). In view of this, there has been increasing interest in delivering more consistent practice in ICUs by developing weaning protocols that provide structured guidelines to achieve prompt and successful weaning. Many studies have shown the benefit of allied health care worker (nurses and physiotherapists) driven weaning protocols in decreasing MV days and costs (MacIntyre 2005; Dries et al 2004; Ely et al 2001). Objectives: The objectives of this study were to determine a) if the number of patients in the ICU has an influence on physiotherapists’ involvement in the weaning of patients from MV, b) if the type of ICU has an influence on physiotherapists’ involvement in the weaning of patients from MV, c) if physiotherapists are involved in the development and implementation of weaning protocols for mechanically ventilated patients in their ICUs, d) if physiotherapists are involved in titration of ventilator settings for patients during the weaning process, e) what modalities physiotherapists in South Africa use to facilitate respiratory muscle strengthening to assist weaning of patients on MV, f) if physiotherapists in South Africa are involved in the extubation of ventilated patients, g) if there is a difference in involvement in weaning of mechanically ventilated patients between newly qualified physiotherapists and experienced physiotherapists. The last objective of this study was to determine if current physiotherapy involvement in the weaning of patients from MV in South Africa is in line with international physiotherapy practice according to the literature. Method: A questionnaire was developed by the researcher using available literature on the nature of involvement of physiotherapists in the weaning of mechanically ventilated patients. Content validation of the questionnaire was achieved after a panel of senior cardiopulmonary physiotherapists analysed each question and their recommendations and adjustments were implemented. Physiotherapists who practice cardiopulmonary physiotherapy in adult ICUs of hospitals in the public and private sectors in South Africa were sought and targeted for the study. The self-administered questionnaire was then posted or emailed to the physiotherapists identified for inclusion into the study. Results: A total of 425 questionnaires were distributed to physiotherapists who practice cardiopulmonary physiotherapy in adult ICUs of hospitals in South Africa. Of the 425 questionnaires distributed, 200 questionnaires were sent via the postal system and 225 were sent via email with a link to an online survey. The response rate for the postal questionnaires was 54.5% (n=109) and 33.3% (n=75) for the emailed questionnaire, giving a combined response rate of 43.3%. The results showed that 76% of South African physiotherapists are not or are seldom involved in the weaning of mechanically ventilated patients in adult ICUs. They are not involved in the development of weaning protocols (74%, n=51), titration and adjustment of MV settings (>80%, n=154), spontaneous breathing trails (67%, n=119) and non-invasive ventilation (58%, n=101). Physiotherapists working in South Africa are somewhat involved in extubation (16%, n=28). The most common physiotherapy modalities used in ICU to facilitate respiratory muscle strengthening are exercises (81%, n= 138), early mobilisation out of bed and deep breathing exercises. (77%, n=134). Physiotherapists’ involvement in the weaning of mechanically ventilated patients are not influenced by the type of ICU they work in (p>0.05), type of physiotherapy degree they have (p=0.24) or whether they are newly qualified physiotherapists or experienced physiotherapists (p=0.43). Conclusion: This survey shows that most physiotherapists who work in adult ICUs in South Africa are not involved in the weaning of mechanically ventilated patients. The survey does show that there is a need for physiotherapists to reconsider their role in ICU with regards to weaning patients from MV as current practice is not in keeping with the international practice of respiratory therapists in the United States of America (USA) and physiotherapists in the United Kingdom (UK), Australia and Europe.

Thesis (M.S.)--University of Wisconsin--Madison, 1985. / Typescript (photocopy). eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 100-103).

Thesis (Ph. D.)--University of Washington, 2000. / Vita. Includes bibliographical references (leaves 67-76).

Thesis (M.S.)--University of Michigan, 1987.

Thesis (M.S.)--University of Michigan, 1987.

Thesis (M.S.)--University of Michigan, 1987.