This phenomenological study was conducted in a rural area serviced by a small community hospital to answer the research question , "what is the lived experience of the spouse of the critically ill patient." The informants were three female spouses who had experienced critical care as the spouse of a critically ill male patient within the past year. Once verbal consent was obtained, written consent was obtained by sending a letter explaining the study, along with a consent form describing the risks and the benefits.Data were collected by means of tape-recorded unstructured forty-five minute interview. The study was strictly voluntary and all tape-recorded data collected were identified by numbers only and destroyed at the completion of the study. The informant was asked the question, "Tell me what it was like for you when your husband was critically ill?" Data were analyzed via the hermaneutical process of Heidegger as outlined by Giorgi.Each informant was provided the opportunity to reflect and recall this lived experience. The informants shared seven common themes even though each experience was individually unique and separate. The seven themes that emerged were (a) fear, (b) educational needs, (c) self-sacrifice, (d) center of focus shift, (e) family event, (f) the need to discuss system contact and, (g) tomorrow.The themes suggest that closure has not occurred for the spouse of the critically ill person. The findings indicate that the event is not limited to the initial hospitalization, but that long term changes and perceptions are apparent from the informants' perspectives.Implications for the nurse clinician, nursing education and research were described. Recommendations for further research include further study on the long term effects of critical illness on the spouse of the critically ill client. / School of Nursing

This study explores the use of early warning scores (EWS) in deteriorating patients. These are widely used tools to measure vital signs and highlight abnormal physiology in acutely unwell patients. Measurements of the process in the management of the deteriorating patient includes time to first assessment of such patients. The level of clinician involved in the subsequent management is also investigated to determine whether escalation of care was appropriate. This work is a retrospective case note analysis of the recognition and management of deteriorating patients prior to critical care admission. Research Questions 1. What violations in the optimum process are associated with sub-optimal recognition and management of deteriorating patients and delayed critical care admission in patients triggering early warning scores in acute care wards? 2. Are there independent variables which can predict the delay in the recognition and management of deteriorating patients and subsequent critical care admission? Methods The literature was reviewed to determine the optimum process of recognition and management of deteriorating patients in acute care wards. A data collection tool was then specifically designed and locally validated to extract objective data from the case records. A sample of 157 patients admitted to critical care from acute wards over a 6 month period were included in the study. The case records were then retrospectively reviewed and information was extracted using the data collection tool. Results The accuracy and frequency of early warning scores were measured and findings demonstrated that 59% of Early Warning Scores (EWS) were miscalculated. The most frequent of those miscalculated were the intermediate scores (4 or 5) (error rate - 52%) followed by the higher scores (6 or more) (error rate - 32%). The least frequently miscalculated were the lower scores (0 -3) (error rate 15%). Descriptive data from the sample such as age, ward, diagnosis, time of hospital admission, time and day of transfer / EWS triggering were included. From the total case records reviewed, 110 patients had abnormal Early Warning Scores (4 or more) and were included in the inferential data analysis. The independent variables related to the processes objectively measurable in the recognition and management of deteriorating patients were included. After descriptive analysis the independent variables were cross-tabulated with the dependent variable using Pearson chi-square. The dependent variable was identified from the literature. This was whether time from triggering an abnormal EWS to critical care admission was delayed more than 6 hours. The subsequent predictor variables were then entered in to a binary logistic regression model for statistical analysis using SPSS version 21 software. Binominal Logistic Regression Analysis identified three significant variables predicting delay of the recognition and management of deteriorating patients. • Frequency of EWS measurement not increased appropriately • Length of stay prior to critical care admission 12-36 hours • If no consultant review during 6 hours of abnormal EWS Implications for Future Practice This study highlights areas of risk in the detection of patients’ clinical deterioration in acute wards. These findings should guide quality improvement to prevent unnecessary morbidity and mortality. As a key area of patient risk included the lack of frequency and accuracy of EWS measurements, staff education is required to ensure staff are given the appropriate knowledge to understand the use of the tool. Regular review of the frequency of measurement is also required as this was statistically significant in the delay to critical care admission. The high risk time from admission of 12-36 hours needs further investigation. This study also highlights the need for senior decision makers to be involved in the care of deteriorating patients to improve outcomes.

Background: Comprehensive oral care is an evidence-based, cost effective, essential routine nursing intervention that nurses ought to provide with good knowledge/understanding as it prevents and controls nosocomial infections especially Ventilator Associated Pneumonia (VAP) that is associated with increased morbidity and mortality in critically ill patients in Intensive Care Units (ICU). Aim of study: To determine ICU nurses’ knowledge, describe their practices and identify their perceptions regarding comprehensive oral health care to critically ill patients in order to refine or develop evidence based oral care protocol. Methods: A quantitative approach with a descriptive, exploratory survey was used for this study. A non probability convenience sample of thirty-four (34) ICU nurses from two public referral hospitals participated in this study. A questionnaire with a combination of open and closed ended questions was used to collect data on comprehensive oral care to critically ill patients. Results Thirty-four nurses responded to the questionnaire (response rate 89%). Only 18% (n=6) were knowledgeable about important aspects of oral care, while the majority, 82% (n=28) lacked knowledge on important aspects of oral care. Fifty-nine percent (59%) n=20 had received training on comprehensive oral care at basic nursing training and 44% (n=15) had orientation at unit level. Ninety-seven percent (97%) n=33 of the participants requested further updates on comprehensive oral care. No significant relationships were found between nurses’ demographic characteristics and knowledge of comprehensive oral care. All (100%) n=34 of nurses gave oral care a high priority and 91% ranked it very important for critically ill patients. Toothbrushes and toothpaste were used by 85% (n=29) of nurses and only 50% (n=17) used mouthwashes. The reason for non- use of mouthwashes was lack of supplies and not having been foreseen in unit protocol although neither of the units had an oral care protocol in place. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.