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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 Master of Medicine in the branch of Paediatrics and Child Health 29 May 2017 / Introduction Sepsis, and in particular, severe sepsis, remains a major cause of death in children worldwide. One of the areas where the burden of sepsis is keenly felt is in the paediatric intensive care unit (PICU) setting, contributing significantly to childhood mortality. Fungal organisms have emerged as a major organism contributing to nosocomial sepsis in PICU. No local data regarding nosocomial fungal sepsis in the non-neonatal, PICU population exists regarding this matter. This study describes the characteristics of patients with nosocomial fungal sepsis in the PICU at South Africa’s largest hospital Chris Hani Baragwanath Academic Hospital (CHBAH). Methods This study was a retrospective review of patient records. All patients aged 0-16 years admitted to the PICU at Chris Hani Baragwanath Academic Hospital (CHBAH) from January 2008 through December 2011 were assessed. A total of seventeen patients who developed nosocomial fungal sepsis were included in this study. Results The incidence of candidaemia was reported to be 3.2 per 100 cases. The major age group affected by nosocomial fungal sepsis was the under one age group. The most common diagnoses on admission were lower respiratory tract infection (LRTI) followed by haematology-oncology and acute gastroenteritis cases. ICU factors found to commonly co-­‐exist with proven nosocomial fungal sepsis were presence of a central venous catheter (100%), mechanical ventilation (82%), arterial line (70%), and systemic corticosteroid use (47%). The penicillin class was the most common antimicrobial that patients were found to be on at the time of nosocomial sepsis. The most common fungal organism as a cause for nosocomial sepsis was C. parapsilosis rather than C. albicans. Furthermore, the majority of this study’s isolates were susceptible to voriconazole rather the current empiric antifungal of choice, namely fluconazole. Conclusion The presence of central venous catheters, arterial lines, mechanical ventilation and systemic corticosteroid use is common in paediatric patients with nosocomial fungal sepsis. However, this study was unable to determine statistically significant factors associated with fungal sepsis in a tertiary PICU due to the surprisingly small number of cases (n=35) detected over a four-year period. This perhaps represents the most striking finding of the study together with a concerning pattern of fluconazole resistance (14%) among isolated organisms. / MT2017

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The technological complexity of the ICU is often focused on saving lives however, it is frequently a place to support the dying. Because of the serious nature of critical illness, patients are unable to communicate their wishes, values and views. Family members are often called upon to communicate the critically ill patients’ wishes and many report feeling burdened with the task. The distress described may lead to difficulty mobilizing coping mechanisms and may affect their ability to make appropriate decisions for their family member’s care. Hence, an in depth understanding of the surrogate’s experience is critical to plan effective interventions and provide anticipatory guidance to support the process of making decisions around end of life care. Objective The purpose of the study is to describe the surrogate decision makers’ appraisals of the demands of decision making for a critically ill adult intensive care unit patient and the coping strategies employed by them during this experience. Method A descriptive study design using a qualitative interviewing approach extracted perceived stressors and coping strategies using systematic, focused thematic analysis guided by Folkman and Lazarus’ Stress and Coping Paradigm. Findings Respondents appraisals identified the following perceived stressors: doubt of self efficacy, unknowns, impingement of real life, and problematic relay of information. The surrogates’ perception of their ability to manage the decision making process required their awareness of the decision making role and magnitude of illness, their need to form partnerships, time to reflect on prior discussions and experience, and their appraisal of the patients’ suffering. Participants described emotion and problem based coping strategies they employed during the task. To emotionally justify their decisions, surrogates’ referred to their understanding of patient wishes and sought solace and comfort from the health care staff. In addition, surrogates used strategies to solve problems encountered including dealing with others, employing strategies to decrease their uncertainty and mobilizing time to process the events unfolding. Conclusions End of life decisions in the intensive care are complex and demanding. A better understanding of the process may guide health care professionals in developing focused interventions to assist surrogates through a painful process. / Thesis (Master, Nursing) -- Queen's University, 2008-04-25 09:29:27.1

The psychometric properties of this Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) were assessed, before using the scale to describe stress experienced by parents in a Neonatal Intensive Care Unit (NICU). The extent to which parental stress from the parent-infant relationship in the unit was linked to parenting they received as a child, and adjustment to their couple relationship, was also examined. The sample consisted of 182 mothers and 183 fathers, who were in a cohabitating relationship, of infants from the NICU at Christchurch Women's Hospital. The self-report questionnaires included the PSS:NICU, Parental Bonding Instrument, and the Dyadic Adjustment Scale, and were administered to parents within 2-3 weeks of their infant's birth. This study extends the finding of satisfactory psychometric properties of the PSS:NICU (Franck, Cox, Allen & Winter, 2005; Miles, Funk & Carlson, 1993; Reid & Bramwell, 2003) to this New Zealand sample. Mothers experienced significantly higher stress from the unit compared to fathers (p < .01). A previous finding, for mothers, of the parent-infant relationship being the most stressful aspect of the unit (Franck et al., 2005; Reid & Bramwell, 2003; Shields-Poe & Pinelli, 1997) extends to the New Zealand sample. The most stressful aspect of the unit for fathers was sights and sounds. Lack of evidence was found for associations between parental stress from the parent-infant relationship in the unit and parenting received as a child, or adjustment to their couple relationship. A weak but significant negative correlation was, however, found between stress from the mother-infant relationship and maternal care received in childhood. It is unnecessary to provide all parents with intervention further to what is already being practiced in the unit, as overall low levels of stress were reported. Some parents, however, did find the unit more stressful, and they may benefit from increased intervention.

The psychometric properties of this Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) were assessed, before using the scale to describe stress experienced by parents in a Neonatal Intensive Care Unit (NICU). The extent to which parental stress from the parent-infant relationship in the unit was linked to parenting they received as a child, and adjustment to their couple relationship, was also examined. The sample consisted of 182 mothers and 183 fathers, who were in a cohabitating relationship, of infants from the NICU at Christchurch Women's Hospital. The self-report questionnaires included the PSS:NICU, Parental Bonding Instrument, and the Dyadic Adjustment Scale, and were administered to parents within 2-3 weeks of their infant's birth. This study extends the finding of satisfactory psychometric properties of the PSS:NICU (Franck, Cox, Allen & Winter, 2005; Miles, Funk & Carlson, 1993; Reid & Bramwell, 2003) to this New Zealand sample. Mothers experienced significantly higher stress from the unit compared to fathers (p < .01). A previous finding, for mothers, of the parent-infant relationship being the most stressful aspect of the unit (Franck et al., 2005; Reid & Bramwell, 2003; Shields-Poe & Pinelli, 1997) extends to the New Zealand sample. The most stressful aspect of the unit for fathers was sights and sounds. Lack of evidence was found for associations between parental stress from the parent-infant relationship in the unit and parenting received as a child, or adjustment to their couple relationship. A weak but significant negative correlation was, however, found between stress from the mother-infant relationship and maternal care received in childhood. It is unnecessary to provide all parents with intervention further to what is already being practiced in the unit, as overall low levels of stress were reported. Some parents, however, did find the unit more stressful, and they may benefit from increased intervention.

Resumo: A humanização é vista como um conjunto complexo de atitudes e ações motivadas por pensamentos éticos, humanísticos, sociais e holísticos. Hoje, a proposta de humanização em UTI tem um horizonte mais amplo, englobando desde o ambiente físico até as relações entre as equipes de saúde. Dessa forma, valorizar a presença de acompanhantes na instituição hospitalar e apreender sua percepção é um processo fundamental para o alcance de uma prática assistencial realmente humanizada. Assim, esse estudo tem o objetivo de analisar a percepção do acompanhante de pacientes que estão em processo de hospitalização, na busca da assistência humanizada em Unidade de Terapia Intensiva. É uma pesquisa de abordagem qualitativa, sendo entrevistados os acompanhantes nas UTIs pediátrica e coronariana do HC da Faculdade de Medicina de Botucatu - UNESP. Os depoimentos foram analisados através da Técnica de Análise de Conteúdo proposta por Bardin (96). As categorias identificadas foram: acolhimento e ambiente da UTI: estrutura física e profissionais de saúde. As percepções dos familiares em ser acompanhante refletem uma não diferenciação em ser acompanhante e ser visitante, porém enfatizam que a presença da família, mesmo nos horários de visitas, auxilia na recuperação do paciente, como também os tranqüilizam. Os acompanhantes consideram as informações fornecidas pelos profissionais de saúde, adequadas e verdadeiras. O atendimento das unidades é percebido como satisfatório, porém revelam ser necessário um repensar sobre as normas e rotinas das unidades, principalmente em relação aos horários de visitas. A percepção sobre acomodação reflete a possibilidade de estar próximo ao paciente, porém revelam a dificuldade por não ter um local apropriado para se acomodar que se localize próximo a UTI. Percebem ainda... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Humanization is viewed as a set of complex attitudes and actions motivated by ethical, humanistic, social and holistic thoughts. Today, the proposal of humanization at ICUs has a broader horizon which includes the physical environment as well as relations between health care teams. Hence, valuing the presence of companions in hospitals and apprehending their perceptions is a fundamental process for accomplishing an actually humanized care provision practice. Therefore, this study aimed at analyzing the perceptions of companions of patients undergoing the hospitalization process in the search for humanized care at an Intensive Care Unit. It is a qualitative study in which companions of patients hospitalized at the pediatric and coronary ICUs of the Botucatu School of Medicine University Hospital - UNESP were interviewed. The reports were analyzed through the Content Analysis Technique proposed by Bardin (96). The identified categories were: patient reception and the ICU enviroment - physical structure and health care professionals. Family members' perceptions of being companions reflected a non-differentiation between being a companion and being a visitor; however, they emphasized that the presence of relatives, even if only at visiting hours, helped patients' recovery as well as made them calm. Companions considered the information provided by health care professionals to be adequate and truthful. The care given at the units was perceived as satisfactory although the respondents reported the need to reconsider the units' rules and routine, especially as concerns visiting hours. The perception concerning acommodation reflected the possibility of being close to the patient; however, they revealed the difficulty of not having an appropriate accomodation area near the ICU. They also perceived that the University Hospital... (Complete abstract click electronic access below) / Orientador: Maria de Lourdes da Silva Marques Ferreira / Coorientador: Ione Correa / Banca: Ilda de Godoy / Banca: Maria José Sanches Marin / Mestre

No description available.

M.Sc. (Nursing), Faculty of Health Sciences, University of the Witwatersrand, 2009

Background: Getting admitted to CCU is viewed as a stressful event by patients. However, numerous studies have indicated that nurses do not always accurately perceive the stressors of their clients. Therefore, it is important for nurses to know what seems most stressful from the patients‘ perspective so that appropriate nursing measures can be directed towards minimizing such stressors. Objectives: The purpose of this study was to explore the perception of CCU stressors experienced by patients from both patients and nurses perspective and to compare between them, identify the effect of socio-demographic characteristics of participant's on the level of stress perception and to what extent clinical guidelines fulfil CCU needs. Methodology: A mixed method approach (qualitative and quantitative) was applied. Purposive random sampling was used to recruit data. Ethical approval was obtained prior to data collection. Data was collected from three CCUs within the West and Northwest NHS Trusts. Participants who met the inclusion criteria were interviewed and asked to rank the Environmental Stressor Questionnaire (ESQ). Qualitative data was analyzed using Gorgi's method of analysis. A quantitative data was analyzed using the SPSS software version 15. Results: There was some consistency in the data where patients and nurses provided same ranking for CCU stressors. Consistently nurses ranked physiological stressors higher than psychological stressors. Patients showed consistency in the findings between what they ranked in the ESQ and their narratives more than their counterparts. Perception of stress was affected by participant's socio-demographic characteristics. A key finding is that the current guidelines do not serve patients and nurses needs. Conclusions: Nurses should be well equipped with knowledge and experience to overcome stressful situations. Educational programs should be made available for nurses to improve stress management. Nurses should assess patient's needs by applying effectively communication skills.