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.

Background: Critically ill abdominal surgery patients are at risk of developing a paralytic ileus. Multidisciplinary interventions aim to prevent post-operative complications in the intensive care unit; including interventions to prevent the development of a paralytic ileus. However, the implementation of preventative interventions occurs ad hoc and these high risk patients still develop a post-operative paralytic ileus. Aim: The aim of the study was to explore the implementation of post-operative interventions used in the critical care unit to prevent a paralytic ileus in patients following major open abdominal surgery. Research design and methods: A quantitative, exploratory retrospective research design was used to answer the research question. Patient medical records were retrieved from a specialised intensive care unit situated in a private hospital in Gauteng. A unit of analysis represented the study population and a sample frame was used for choosing patient medical files in the study. Data was collected using a data collection sheet developed from literature. Data was analysed using descriptive statistics (frequency tables, odds ratio, relative risks, Pearson Chi-square test and Fisher’s exact test). Results and Conclusions: After data analysis, the results of the study were documented. Conclusions deducted from this study highlighted three significant interventions associated with the incidence of a post-operative paralytic ileus. Further research on these three interventions may possibly prevent a paralytic ileus in critically ill abdominal surgery patients in the future. Implementation of specific evidence-based post-operative interventions has been recommended to critical care providers of the private hospital group. / Dissertation (MCur)--University of Pretoria, 2020. / Nursing Science / MCur (Nursing Sciences) / Unrestricted

Background: Acute kidney injury occurs in one out of ten cardiac surgery patients. Cardiac surgery-associated acute kidney injury not only increases patients’ mortality rate but the length of stay in intensive care unit and hospital. Cardiac surgery patients’ long- term risk for chronic kidney disease and heart failure increases with the incidence of acute kidney injury. Various preoperative, intraoperative and postoperative risk factors are associated with the development of cardiac surgery-associated acute kidney injury. Aim: The aim of the study was to identify the risk factors associated with acute kidney injury in patients who underwent cardiac surgery. The identified risk factors were categorized into modifiable, partially modifiable and non-modifiable risks. The frequency of acute kidney injury among cardiac surgery patients was also assessed. Research design: The researcher chose a quantitative correlational retrospective design and conducted a retrospective chart review to assess the risk factors associated with AKI in patients that had undergone cardiac surgery. Methods: Non-probability purposive sampling was used to select the records of patients that underwent cardiac surgery between January 2014 and December 2018. Data collection was done using a self-developed audit tool. Descriptive and inferential statistics were used for data analysis. Significance: The study enabled the researcher to identify and categorize the risk factors into modifiable, partially modifiable and non-modifiable categories. Early recognition and mitigation of risk factors could prevent patients from developing cardiac surgery- associated acute kidney injury. Research findings: The study found a 22.7% frequency of CSA-AKI. Anaemia, hypoalbuminemia, hyperglycaemia, use of N-acetylcysteine and fluid overload were identified as modifiable risk factors. Bicarbonate level <22mmol/L, use of diuretics, use of antibiotics, longer duration of surgery, fresh frozen plasma use >500ml on the day of surgery, red blood cell transfusion >1L on the day of surgery and prolonged use of mechanical ventilation were partially modifiable risk factors. No non-modifiable risk factors were identified. Keywords: Cardiac surgery-associated acute kidney injury; risk factors; modifiable, partially modifiable and non-modifiable. / Dissertation (MCur (Critical Care Nursing))--University of Pretoria, 2020. / Nursing Science / MCur (Critical Care Nursing) / Unrestricted

Poor communication is identified as the root cause for the majority of sentinel events in hospitals, including wrong site surgery, medication errors, and failure to rescue. Interdisciplinary rounding (IDR), a long-standing practice in the Intensive Care Unit (ICU), provides a forum for communication and collaboration and has been linked to improved patient outcomes. Most of the research regarding IDR has been performed in the ICU setting within academic medical centers. IDR outside of the ICU has demonstrated similar clinical outcomes but a gap exists in the literature regarding the impact of IDR participation on the nurse, particularly for nurses working in the non-ICU setting within community hospitals. This led to the development of a research question. Basic Psychological Needs Theory was chosen as the theoretical framework – to specifically assess how participation in IDR affected the nurses' sense of autonomy, competence, and relatedness. A mixed method study was conducted in a community hospital in Central Florida using surveys and semi-structured interviews. Results indicated ICU nurses perceived a higher level of collaboration with physicians than nurses working outside of the ICU but this did not correlate with satisfaction of the ICU nurses' basic psychological needs. Only the nurses' level of experience and advanced nursing education appeared to have any significant impact on satisfaction of the nurses' basic psychological needs. The interview responses confirmed the presence of different rounding processes and levels of collaboration outside of the ICU, which helped to explain and support study outcomes. Opportunities for process improvements were also identified.

Healthcare systems have been demonstrably altered because of the COVID-19 pandemic. Resources were stretched and patient conditions deteriorated on a scale previously unseen, leaving nurses at the forefront to face the adversities brought about by the pandemic. In this study, a questionnaire was utilized to better understand how COVID-19 has impacted the stress level, resilience/well-being, moral distress, job satisfaction/enjoyment, practice environment, and intent to remain in the nursing profession of nursing alums from East Tennessee State University. This study focused on a subset of nurses working in critical care, to consider the impact that the pandemic had on ICU nurses’ emotional well-being and job enjoyment. This study collected general demographics and information regarding how each participant’s work was impacted as a result of COVID-19. The Practice Environment Scale of the Nursing Work Index (PES-NWI) questionnaire, Job Enjoyment Scale (JES), and Professional Quality of Life (Pro-QOL) scales were also leveraged to gain an understanding of the participants’ perspectives on their work and mental situations. The results showed that critical nurses generally answered more negatively on the PES-NWI, JES, and ProQOL scales. The study concludes that ICU nurses have lower emotional well-being and job enjoyment than nurses in general and may have been more greatly impacted by the COVID-19 pandemic.

A research report submitted to the Faculty of Health Science, University of Witwatersrand, Johannesburg ,in partial fulfillment of the requirements for the degree of Master of Science in Nursing, September, 2013 / Background: Despite many advances on evidence-based practice (EBP), nursing is still not based on evidence. Trained intensive care unit (ICU) nurses may be the key to EBP in the ICU. Purpose: To describe the knowledge, attitudes and practices of trained ICU nurses on EBP at an academic hospital in Gauteng. Design: Mixed methods sequential explanatory. Method: Data were collected from trained ICU nurses who were purposely selected using a validated tool (Upton & Upton, 2006) to obtain the quantitative results on their knowledge, attitudes and practices on EBP (n=100) and then followed up with 12 expert trained ICU nurses in two focus groups to explore the quantitative results in more depth. The quantitative and qualitative findings were then combined at discussion of results. Results: From the quantitative results, the majority of the nurses selected the best category: 81.0% on knowledge towards EBP, 75.0% on attitudes towards EBP and 75.0% on practices towards EBP. The qualitative results identified three categories: perceptions, challenges and suggestions. The trained ICU nurses were knowledgeable in their understanding of EBP but lacked knowledge in the skills of accessing evidence. Welcoming attitudes towards EBP were displayed but admitted to their practices being partly evidence-based due to challenges that included resistance to change, confusion of evidence, lack of resources, time and autonomy. The instrument was found to be reliable and valid with a Cronbach’s alpha of 0.94 for the entire questionnaire and the study increased its validity in the South African context. This study indicates that although trained ICU nurses are knowledgeable about EBP, they are still lacking in skills regarding EBP. Even though the trained ICU nurses have welcoming attitudes towards EBP, their practices towards EBP are not fully evidence-based due to the identified challenges. This study therefore suggests capacity building of the trained ICU nurses as well as development of their EBP skills to support EBP.

No description available.

Continuous professional development (CPD) is used to support the development and progression of professions. As nursing regulated by the South African Nursing Council (SANC), has no CPD system, the study’s aim was to describe critical care nurses opinions regarding CPD, their current participation in CPD programs and what they perceive as their potential barriers to CPD. It is envisaged that this study will provide information to consider in developing a CPD framework to support critical care nurses with life long learning. The research design was quantitative using a non experimental, descriptive survey approach, comprised of two phases using Lynne’s model (1986). Data results showed similarity with international literature: significant needs for knowledge and skills related to new technology, attitudinal improvement and professional networking with critical care nurses internally driven to participate in CPD programs and significant barriers to being lack of knowledge in how to access CPD events communication and a lack of communication.

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, 2014 / Discrepancies exist between how pain is assessed in ICU patients able and unable to self report. There are pain assessment scales and guidelines that have been developed over the years for pain assessment. However, little is known regarding ICU nurses’ knowledge and current practices in the provision of pain management in the critically ill. The purpose of this study was to investigate intensive care nurses’ knowledge and practices related to pain assessment for critically ill patients. A quantitative non-experimental, descriptive cross-sectional design was used to achieve the objectives. ICU nurse participants (n=79) were drawn from the five (5) adult ICUs in a public tertiary hospital. Data were collected using a self-administered questionnaire by Rose et al. 2011. Descriptive and inferential statistics were used to analyze the data.