Introduction: The aim of this study was to assess the Acute Physiology and Chronic Health Evaluation (APACHE II) prognostic index in the Intensive Care Unit of Kimberley Hospital Complex (KHC) on admission. The study was more specifically aimed at patients meeting criteria for the Systemic Inflammatory Response Syndrome (SIRS), as patients admitted to KHC ICU frequently meet the criteria and often progress to sepsis, severe sepsis and septic shock. Design: A cohort study on South African patients meeting SIRS criteria, including all races and gender. Setting: Intensive Care Unit of Kimberley Hospital Complex, provincial hospital in the Northern Cape province, South Africa. Patients and measurements: Consecutive patients meeting the criteria for SIRS on admission to ICU between August 2006 and May 2007 were included. For each patient the diagnosis, physiological and chronic health data necessary for the APACHE score was gathered and recorded by the doctor on duty on time of admission. Predicted and actual mortality rates were calculated. Data was provided to the department of Biostatistics of the UFS for processing. Results were summarised by means, standard variations and percentiles (numerical variables) and frequencies and percentages (categorical variables). Results Of the 160 patients included in the study, 59 died (36.9%). Patients discharged from the unit before 14 days were followed up in the ward until 14 days or discharge from hospital (whichever came first). 77 patients were discharged from ICU within 14 days of which 3 (1.9%) died in the ward within the 14-day period. 74 of the discharged patients (46.3%) were alive after 14 days. 24 patients (14%) participating in the trial were still in ICU after 14 days and mortality not recorded. The counting of patients who survived and those who died, for each level of death risk predicted, allowed the calculation of sensitivity, specificity and the percentage of correct predictions for each level of predicted death risk. The sensitivity of the calculated death risk was higher at scores below 8, gradually decreasing as scores increased, reaching 50.9% at score >21. Conversely the specificity increased from 1% for scores <5, reaching 79.2% for death risk at scores >21. The most accurate combination of sensitivity and specificity was found at scores of 16-18, with the positive prediction value ranging from 51.3-54.4% and the negative prediction value ranging from 76.1-77.5%. There was a meaningful connection between APACHE II scores and the mortality rate, for all patients and each diagnostic group. In each successive APACHE II score interval the mortality rate was higher than that of the preceding interval. Thus, the result has confirmed the capability of this index to stratify such patients according to the degree of severity of their health condition. Conclusion The APACHE II scoring system may be usefully applied in Intensive Care Units for predicting mortality, classifying and assessing severity of disease and evaluating performance. It must however be used with caution for planning department resource allocation and decision making regarding admission of patients to Intensive Care.

The aim of this study was to determine the knowledge of critical care nurses regarding forensic and liability issues in the critical care environment in order to design an education programme on the topic. A quantitative, descriptive, contextual research design was used and convenience sampling implemented. A survey, using a questionnaire as measuring instrument, was conducted among critical care nurses in selected private hospitals in South Africa. The response rate was 85%. Validity and reliability of the research was ensured. The total average percentage achieved by the group of 171 respondents was 38.46%, which was 21.54% below the set competency indicator of 60%. Only nine respondents achieved a percentage of or above 60%. Results proved that the respondents required intensive training on the topic. The outline of an education programme to address knowledge deficiencies regarding forensic and liability issues in the critical care environment was presented in PowerPoint presentation format. / Dissertation (MCur (Clinical))--University of Pretoria, 2007. / Nursing Science / MCur / unrestricted

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The purpose of this descriptive study was to describe critical care nurses knowledge and experience regarding the acutely confused elderly. A questionnaire, developed by the investigator, was mailed to two hundred nurses who were members of the American Association of Critical Care Nurses (AACN). The questionnaire consisted of three parts; a case study and questions assessing the respondents' knowledge of acute confusion, questions about the respondents' past personal experiences with the elderly, and a section on demographics. The response rate was 45%. The essential findings were: 1) the mean score on the knowledge items was 60% correct 2) ICU nurses had limited personal experiences with confused elderly people 3) neither level of education nor years of nursing experience affected how well the respondents did on the knowledge items 4) ICU nurses tended to attribute the cause of acute confusion in an elderly patient to ICU psychosis. Further research needs to be done on the etiology and characteristics of acute confusion and on nursing actions and interventions concerning the acutely confused elderly patient. The concept of ICU psychosis needs to be further explored. / 2999-01-01

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 Masters of Science in Physiotherapy. Johannesburg, 2015 / Patients admitted to the intensive care unit (ICU) require continuous monitoring and care from all staff working in ICU; this includes doctors, nursing staff, physiotherapists, dieticians and various other medical staff. Conventionally ICU was predominantly staffed by physicians and nursing personnel, with other members of health care having a minor part to play in the patient’s care whilst in ICU. Depending on the country, type of unit, amount of staff and level of training, the physiotherapist may screen the patients to assess if they require physiotherapy and if so, what intervention will be required; on the other hand, in some units the physiotherapist may rely on referral from the doctors and administer the treatment requested by the doctor for the particular patient. In 2000, Norrenberg and Vincent conducted a study to establish the profile of physiotherapists working in ICU in Europe. Van Aswegen and Potterton (2005) adjusted the questionnaire compiled by Norrenberg and Vincent (2000) to be more suitable for the South African setting. A pilot study using this questionnaire was done to determine the scope of practice of physiotherapists in ICU in South Africa. The content of the modified questionnaire used by Van Aswegen and Potterton (2005) was not validated prior to its implementation and a sample of convenience was used. Results reported from that survey were therefore only preliminary and no additional surveys had been performed to date. Objectives: The aim of this study was to establish the current scope of practice of physiotherapists in ICU in South Africa. To determine if physiotherapists’ scope of practice in ICU in South Africa has changed since the report published by Van Aswegen and Potterton (2005). To compare South African physiotherapists’ scope of practice in ICU with that reported on an international level. Methodology: A pre-existing questionnaire used by Van Aswegen and Potterton (2005) was content validated for this study. After consensus was reached on the final version of this questionnaire, it was uploaded onto SurveyMonkey. Physiotherapists that worked in ICU in the government sector, hospitals belonging to the Life, MediClinic and NetCare groups or that were members of the Cardiopulmonary Physiotherapy Rehabilitation Group of the South African Society of Physiotherapy were invited to participate in this study. Results: A total of 319 questionnaires were sent out and 108 responses were received. The combined response rate for this survey was 33.9%. An assessment technique that was performed ‘very often’ by respondents was an ICU chart assessment (n=90, 83.3%), auscultation (n=94, 81, 8%) and strength of cough effort (n=81, 75%). Assessment techniques that were ‘almost never’ or ‘never’ used included assessment of lung compliance (n=75; 69.4%), calculation for the presence of hypoxemia (n=74; 68.5%) and patient readiness for weaning (n=63; 58.3%). Treatment techniques performed by respondents ‘very often’ included manual chest clearance techniques (n=101, 93.5%), mobilising a patient in bed (n=91, 84.3%), positioning a patient in bed (n=91, 84.3%), airway suctioning (n=89, 82.4%), mobilising a patient out of bed (n=84, 77.8%), deep breathing exercises (n=83, 76.9%) and peripheral muscle strengthening exercises (n=79, 73.1%). Treatment techniques that were ‘never’ or ‘almost never’ used included the flutter device (n=77, 71.3%), implementation and supervision of non-invasive ventilatory support (n=77, 71.3%) and adjustment of mechanical ventilation settings for respiratory muscle training (n=76, 70.4%). Physiotherapists working in the private sector made up 60.2% (n=65) of the respondents. An afterhours physiotherapy service was provided to ICU patients by 78 (72.2%) of the respondents during the week. One hundred and five (97.2%) of the respondents provided a physiotherapy service for ICU patients over the weekend. When comparing the results of the current study to the studies by Norrenberg and Vincent (2000) and Van Aswegen and Potterton (2005), there was a significant difference (p < 0.05) in the usage of IPPB/NIPPV, weaning patients from MV, adjustment of MV settings and IS between the studies. Results from the current study showed a significant difference (p < 0.05) in the involvement of respondents in suctioning, extubation and adjustment of MV settings compared to that reported by Norrenberg and Vincent (2000). Conclusion: Physiotherapists in this study performed a multisystem assessment of their patient’s which is important since physiotherapists are first line practitioners in South Africa. Physiotherapists play an important role in treating and preventing respiratory and musculoskeletal complications that occur in ICU. The results from this study showed that physiotherapists in South Africa are treating their patient’s according to evidenced based practice but due to the high nonresponse bias these results should be interpreted with caution. The results from this study can be used to develop preliminary clinical practice guidelines for physiotherapists working in ICU in South Africa.

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 Science in Nursing Johannesburg, 2017 / South Africa has emerged as the rainbow nation. The Changing demographics within the country has resulted in cultural diversity within the health care system, including the Critical Care units. The purpose of this study was to investigate the level of cultural competence of Critical Care nurses working in culturally diverse Critical Care units in South Africa, in order to make recommendations of whether the skills of cultural competence can assist Critical Care nurses in caring for the needs of culturally diverse patients and their family members. The setting for the study is the members of the Critical Care Society of Southern Africa (CCSSA). A non-experimental, exploratory, descriptive and cross-sectional survey design was used in this study. A non-probability convenience sampling method was utilised. Data was collected by means of a self-administered questionnaire developed by Schim, Doorenbos, Benkert and Miller (2007) which explored the knowledge, feelings and actions of Critical Care nurses’ and skills of cultural competence, inclusive of cultural awareness and sensitivity and cultural behaviour. The questionnaire was administered via an on-line survey using RED CAP with feedback responses from participants via email. Findings in the study revealed 43.6% of the nurses rated themselves as very competent, 42.3% as somewhat competent and 17% as somewhat incompetent. In regard to the nurse respondent’s cultural awareness and sensitivity, the total mean score was 5.29 (SD 0.60), which showed a moderately high level of cultural awareness and sensitivity. In regard to the nurse respondent’s cultural behaviours, the total mean score was 4.06 (SD 1.30), which showed a moderate level of cultural competence. Cultural competence may well be the solution to improving quality of health care, improving patient outcomes and decreasing health care disparities. / MT2017

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 / Collaboration is an interpersonal relationship among colleagues sharing the same goal, power, authority and decision making (Dougherty & Larson, 2010). Collaboration is described as a marker of a nurses’ ability as well as a professional obligation. However, current clinical practice indicates that, as nurses attempt to collaborate with each other, they also employ aggressive, hostile and intimidating behaviours that may result in tension among senior and junior nurses. This carries the risk of medical errors that will lead to poor patient outcomes and job dissatisfaction. This study sought to determine the extent and nature of collaboration practices among nurses in the intensive care settings, with an intention of making recommendations for clinical practice and education. The setting for the study was the Intensive Care Units (ICU’s) (n=5); trauma, cardiothoracic, coronary care, general and neurosurgical units of a public sector and tertiary level hospital in Johannesburg. A non-experimental, descriptive and quantitative study design was utilized in the study. The sample comprised of 112 (n=112) nurses working in the intensive care setting. Non-probability, convenience sampling was employed in this study. Data was collected using a structured questionnaire developed from the Nurse-Nurse Collaboration Scale, which has 35 items on a four-point Likert type scale. The instrument is divided into five subscales of problem solving, communication, coordination, shared process and professionalism. Data was analyzed using factor analysis and descriptive statistics. The data was then analyzed using descriptive and inferential statistics. Statistical assistance was sought from the biomedical statistician at the Medical Research Council (MRC) South Africa. Generally, in this study the results have shown that nurses have more positive perceptions and attitudes about collaboration in the Intensive Care Units, as evidenced by the frequency scores with nurses responding more positively to the five subscales even though some missing data was identified on some of the responses. However, the subscales of communication, shared process, coordination and professionalism scored higher; most of the participants either agreed or strongly agreed to all these items compared to conflict management in item 1.1, where the majority disagreed ignoring the issue pretending it will go away. In item 1.2, the majority agreed to withdraw from conflict; similarly for item 1.5 disagreements between nurses were ignored, or avoided. Correct conflict management amongst nurses is very important for effective delivery of care and collegial working relationships; nurses’ are urged to learn the skills of resolving conflict amicably by compromising in order to consider the interests of all parties. These results showed that females dominate the nursing profession with males being a minority and no differences in collaboration were observed. Participants’ responses for work experience were examined to determine if there was any impact on how nurses perceive collaboration between senior and junior nurses. However, the study results indicated there was a statistically significantly (p<0.05) difference in perceptions of collaboration practices in two of the five subscales; namely communication and shared process between junior and senior nurses in the Intensive Care units. In their responses to an open-ended question, nurses felt that some of their roles overlapped creating confusion as to who was supposed to do what and as a result, it became difficult to maintain effective collaboration amongst team members, compromising the delivery of patient care.

The concept of family witnessed resuscitation in South African critical care areas is one that is rarely practiced. In the majority of cases family members are ushered away from the resuscitation area, and this task is usually one that is performed by the critical care nurse. Consequently, the critical care nurse in the South African public health sector is relatively inexperienced in family witnessed resuscitation. In addition to this, few institutions have written policies with regards to family presence. Hence, the importance of uncovering critical care nurses opinions and perceptions of family presence during resuscitation. Therefore, the aim of this study was to explore and describe a select group of critical care nurses perceptions and opinions regarding family presence during resuscitation. A qualitative study was undertaken in which one-on-one semi structured interviews were conducted as a means of data collection. The following question was asked of the participants, ‘As a critical care nurse, if your patient was been resuscitated, and the family members requested to be present, how would you feel?’. In addition to this the following question was asked of the participants with regards to written policy within the institution used in this study, ‘Is there a policy in place in this institution regarding family presence?’. A total of 11 interviews were conducted including participants of various cultures and previous experiences of family witnessed resuscitation. The data collection and analysis processes were integrated as each interview was directly transcribed following the interview. The data analysis process was guided by Tesch’s method for qualitative data analysis. Four nurses interviewed in this study felt that family witnessed resuscitation is unacceptable, and two were unsure. However, these nurses did waver with regards to this. Nine participants expressed reservations regarding family witnessed resuscitation including the potential traumatic effects that it could have on the family. In addition to this, four participants had concerns that family members might interfere with resuscitation efforts came to light. Six participants also feared that their own shortcomings might be exposed to family members should they observe resuscitation attempts. Three nurses in this study believe that family members may misinterpret issues pertaining to resuscitative efforts, and that the physical space at the bedside would be inadequate. Six participants pointed out that it is norm to ask family members to leave the resuscitation area, in part due to habit, and thus could be preventing family members being invited to the bedside. In addition to this, lack of policy guidelines may be acting as a barrier to allowing and facilitating nurses to invite family members to witness resuscitation. In contrast, five nurses in this study had accepting views on family witnessed resuscitation. This, despite the lack of previous experience these nurses had with regards to family witnessed resuscitation. And as mentioned, nurses did waver with regards to this. Psychological pre-preparation of the family emerged as a concern for three participants. Three of the eleven nurses interviewed would extend an offer to family members to be at the bedside during resuscitation. Four participants felt that a benefit to family witnessed resuscitation is the opportunity it may offer for closure for the family should the resuscitation attempt be unsuccessful. In concluding, the participants in this study are inexperienced in the field of family witnessed resuscitation, and most participants wavered with regards to their perceptions with regards to family witnessed resuscitation.

by Lee Yuet Ming, Isabella. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (leaves 85-92). / Abstract and questionnaire also in Chinese. / ACKNOWLEDGEMENTS --- p.i / ABSTRACT --- p.ii / TABLE OF CONTENTS --- p.iv / LIST OF TABLES --- p.vi / LIST OF FIGURES --- p.vii / LIST OF APPENDICES --- p.viii / Chapter CHAPTER 1 --- INTRODUCTION / Background of the study --- p.1 / Purpose of the study --- p.2 / Chapter CHAPTER 2 --- LITERATURE REVIEW / Concept of family as a system --- p.3 / Family as a supportive system to patients --- p.7 / Critical illness as a family crisis --- p.8 / Family needs of critically ill patients --- p.14 / Met and unmet needs --- p.21 / Person most suitable to meet the family needs --- p.24 / Summary --- p.26 / Chapter CHAPTER 3 --- METHOD OF THE STUDY / Aims and objectives --- p.28 / Operational definitions --- p.28 / Design --- p.29 / Sampling --- p.31 / Access --- p.32 / Data Collection --- p.33 / Ethical considerations --- p.42 / Data analysis --- p.43 / Chapter CHAPTER 4 --- RESULTS / Demographic data --- p.47 / Results from the questionnaire - CCFNI --- p.50 / Results from the interview --- p.56 / Summary --- p.63 / Chapter CHAPTER 5 --- DISCUSSION / Administration of the revised CCFNI --- p.65 / Critical illness threatened the stability of the family system --- p.65 / Relative importance of the family needs --- p.66 / "Additional cognitive, emotional and physical family needs" --- p.67 / Reactions to the patient's critical illness and hospitalization --- p.72 / Unmet needs of the family --- p.73 / Persons suitable to meet the important family needs --- p.75 / Relationship of family needs with demographic variables --- p.76 / Chapter CHAPTER 6 --- "LIMITATION, IMPLICATION & RECOMMENDATION" / Limitation of the study --- p.78 / Implication for nursing practice --- p.80 / Recommendations for further research --- p.83 / REFERENCES --- p.85

Delirium is an acute change in cognition accompanied by inattention, which affects up to 88% of adult critical care patients. Delirium causes increased hospital complications, longer lengths of hospital stay, functional disability, cognitive impairment, and increased mortality. The purpose of this evidence-based quality-improvement project was to implement and evaluate a delirium screening process in adult intensive care units at a large medical center. This included education of nurses, implementation of a structured, validated tool, and review of tool use documentation. The implementation of this project was guided by an evidence-based practice model, Disciplined Clinical Inquiry-© and Lewin's change theory. Evaluation of this quality-improvement project used audits of the electronic medical record. The audits included the presence and accuracy of delirium screening documentation in the patients' medical records. Results of 3 sequential documentation audits revealed a gradual adoption of this practice change by nurse clinicians. The percentage of charts with missing, incomplete, or inaccurate data decreased from 50% on the first week to 27.9% and 25.0% on the 2nd and 3rd weeks, respectively. These findings were an indication of practice change by validating the requirement for delirium screening on the units. In the first 3 weeks alone, 17 patient audits were positive for delirium, indicating the potential for poor short-term and long-term patient outcomes if not addressed promptly. Implementation of delirium screening ensures the dignity and worth of adult critical care patients by decreasing the poor outcomes associated with the diagnosis, which is an important contribution to positive social change.

Delirium is an acute change in cognition accompanied by inattention, which affects up to 88% of adult critical care patients. Delirium causes increased hospital complications, longer lengths of hospital stay, functional disability, cognitive impairment, and increased mortality. The purpose of this evidence-based quality-improvement project was to implement and evaluate a delirium screening process in adult intensive care units at a large medical center. This included education of nurses, implementation of a structured, validated tool, and review of tool use documentation. The implementation of this project was guided by an evidence-based practice model, Disciplined Clinical Inquiry© and Lewin's change theory. Evaluation of this quality-improvement project used audits of the electronic medical record. The audits included the presence and accuracy of delirium screening documentation in the patients' medical records. Results of 3 sequential documentation audits revealed a gradual adoption of this practice change by nurse clinicians. The percentage of charts with missing, incomplete, or inaccurate data decreased from 50% on the first week to 27.9% and 25.0% on the 2nd and 3rd weeks, respectively. These findings were an indication of practice change by validating the requirement for delirium screening on the units. In the first 3 weeks alone, 17 patient audits were positive for delirium, indicating the potential for poor short-term and long-term patient outcomes if not addressed promptly. Implementation of delirium screening ensures the dignity and worth of adult critical care patients by decreasing the poor outcomes associated with the diagnosis, which is an important contribution to positive social change.