Not available / text

Critical care nurses often face the ordeal of witnessing a patient's death in a tense and stressful environment. Anecdotal stories shared among nurses reveal that unusual experiences often occur at the time of or after a patient's death. This hermeneutic phenomenological study explored the meaning of these experiences for critical care nurses. Using Parse's research method, in-depth interviews were conducted with six critical care nurses who described their experiences at the time of a patient's death as well as during the post-death period. These experiences brought a sense of peace and comfort to each individual as well as reinforced their individual belief patterns about life after death. A distinctive sense of nursing knowing at the time of death was also identified. The findings of this study indicate that the experiences of the phenomenon of death by critical care nurses have a significant impact on each individual and that further research and understanding of this impact is needed. / ix, 113 leaves ; 29 cm.

Introduction. The use of Highly Active Antiretroviral Therapy (HAART) has shown to reduce the morbidity and mortality and prolongs survival, improving quality of life restoring and preserving immunologic function, maximizing antiretroviral activity and durably suppressing viral load and further preventing vertical HIV transmission. However, their use in Critical Care Units CCU is still controversial as there are still no set standards for how HAART should be applied in these settings (Anderson, 2009). This study was aimed at exploring the perceptions of critical care nurses towards their educational preparedness in managing HIV/AIDS patients admitted to CCU in KwaZulu-Natal. Methodology. Quantitative descriptive research design was used and data collection included a structured questionnaire and open ended questions. Results. The findings of this study indicate that of the critical care nurses who were sampled for this study and had undergone training in HIV/AIDS management, 45% and 25% respectively perceived that they were not educationally prepared to provide services for people living with HIV/AIDS admitted to CCUs. Almost all N=50 (94%) critical care nurses reported that HIV/AIDS management should be incorporated into the critical care nursing programme. Their universal perception N=42 (75%) is that this will improve the standards of nursing care in the critical care field. Over and above lack of training and updated information reported by the respondents, they are still challenged by factors such as advanced level of HIV disease, confidentiality about the disease, knowledge about a HIV/AIDS treatment regimen and emotional challenges. However, there are guiding policies within critical care settings for nurses to utilise in the management of HIV/AIDS and in the care of people who have already been infected. Conclusion and recommendations. In conclusion, more research with a larger scale sample is required to provide appropriate generalisation of the findings of the study. Alternatively a qualitative research study which may provide richer data on the lived experiences of the critical care nurses regarding care of people living with HIV/AIDS is suggested. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

Aim: The aim of this study was to investigate the educational shortcomings as evident in the literature reviewed with the intention of developing intervention/s thus contributing to practice, management, research and education. Background: Literature identifies many limitations in psychosocial support to families of patients in ICU. Little is known about the continued educational support the ICU nurses receive, formally and informally, to empower them to provide psychosocial support to the families of ICU patients. Methodology: The mixed method (concurrent triangulation design), was adopted using the survey for both the quantitative and qualitative approach. In-depth interviews, conversations, participative observation and the review of documents were used to collect data. Collection of data occurred simultaneously. A research instrument and guide were used to obtain quantitative and qualitative data respectively. Setting: Purposive sampling was used for the selection of hospitals within which the chosen ICUs were located and the educational institutions which provided the formal education and training to ICU nurses who worked in these hospitals. Participants: The qualitative arm involved interviews with a purposively selected sample of critical care nurses. Saturation was reached after nine interviews. A sample size of 34 (n=34) was used in the quantitative arm of the study. Convenience sample was used. Data Analysis: A mixed method approach was adopted. The study applied a thematic analysis according to the qualitative analysis described by Creswell 2007. Descriptive statistics were used to summarize data and findings were presented in tables and graphs. The SPSS version 15.0 and STATA statistical package calculate non – parametric tests between selected study variables. Findings: The main themes derived from the qualitative analysis and confirmed by the statistical data demonstrated the manner in which continued education preparation was inadequate, the lack of specific clinical accompaniment, the lack of direction in terms of the philosophy of the units, ICU nurses being left on their own to obtain educational preparation. The results indicated that the lack of continued informal education at the unit and hospital level influenced the ICU nurses’ lack of implementation of psychosocial support to families of ICU patients. Statistical results and qualitative themes were converged and integrated during data analysis. Jamerson et al.’s (1996) model of family experience was used to contextualise the findings. Recommendations: Recommendations arising from the study were made for improvements in nursing practice, nursing management, nursing education and future nursing research. A practice checklist was formulated and expert opinion was sought using the Nominal Group Technique. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

Patient satisfaction is an outcome of care that represents the patient's judgment on the quality of care. An important aspect of quality affecting patient's judgment can be attributed to patients' expectations and experiences regarding nursing care according to type of unit. The purpose of this study was to examine differences between patients' perceptions of satisfaction with nursing care in critical care units and medical units in one Midwestern hospital.The conceptual framework was "A Framework of Expectation" developed by Oberst in 1984, which asserted that patients have expectations of hospitals and health care professionals regarding satisfaction and dissatisfaction with care. The instrument used to measure patient satisfaction was Risser's Patient Satisfaction Scale, with three dimensions of patient satisfaction: (a) Technical-Professional, (b) Interpersonal-Educational, (c) Interpersonal-Trusting. The convenience sample included 99 patients50 from critical care units and 49 from medical wards. Participation was voluntary. The study design was comparative descriptive and data was analyzed using a t-test.The demographic data showed that the majority of patients had five or more admission. About one-third of the patients were 45-55, 56-65, 66-75, respectively. Findings related to the research questions were that: (a) 84 percent of the respondents rated overall satisfaction in the satisfactory to excellent range, (b) results of a t-test showed significant differences in overall patient satisfaction with patients being more satisfied with care in critical care units. Significant differences were found in three subscales with critical care being more satisfied. No relationship was found between patient satisfaction and age/and/or type of unit.Conclusions were that in both medical and critical care units patients were more satisfied with Technical-Professional and Interpersonal-Trusting than with Interpersonal-Educational. Also noted was that patients in the units where nurse-to-patient ratio was higher participants perceived that nurses had more time, energy and ability to meet patient expectation. Implications call for analysis of nurse/patient ratio in relation to patient satisfaction and nurses in relation to patient education as well as patient's perceptions of getting their needs met. / School of Nursing

Globally the population is ageing and as a consequence people are living longer with multiple chronic conditions. A range of factors, including decreased lengths of hospital stay and a greater focus on community based care, has lead to an increasing acuity of patients admitted to acute care settings, many with complex care needs. To date, models of nursing care in acute settings have been configured to focus on acute, procedural care and do not meet the unique needs of the older person. In order to ensure optimal health outcomes of older hospitalised people, nursing care needs to be responsive to the priorities and needs of patients and their families. This study sought to collaboratively develop a model of nursing care with nurse clinicians to improve the care of older people in the acute care setting. Model development was driven by an action research framework, using evidence-based principles and a comprehensive needs assessment. A three phased, mixed method design was embedded within the overarching conceptual and philosophical framework of action research. The first phase of the study comprised a needs assessment and allowed appraisal of the needs of patients as perceived by patients, carer’s and nurses, this was performed using the Caring Activity Scale [CAS](1). Qualitative data and semi-structured interviews added depth to the survey data and qualified responses by confirming that patients thought that nurses did the best they could within a culture of busyness, while patients strived to maintain and sustain their own independence. Managing the discharge process and carer burden arose mainly from the carer semi-structured interviews only. Data revealed significant differences between patients, carer’s and nurses in relation to priority and satisfaction with care. Patients did not place a large importance on discharge care which contrasted with the focus of nursing initiatives. During the subsequent phases of the study a collaborative approach, using action research principles, was used to develop and implement a model of nursing care. A key feature of this model was the introduction of a team structure with a focus on patient centred care. Significant differences were identified in the pre model and post model patient groups in relation to satisfaction with care, with the post model group more satisfied than the pre group model group. Further, improvements in functional status and medication knowledge were demonstrated among patients cared for under the new model. This study has demonstrated that developing a model of care appropriate to the needs of patients, carer’s and nurses can be achieved through the use of action research principles. Study data illustrates the importance of collaboration, empowerment and change management principles in driving clinical improvement and patient satisfaction with care. The findings also underscore the importance of promoting and educating patients and carers as well as nurses about the importance of discharge planning to optimise post-discharge health outcomes. / Doctor of Philosophy (PhD)

Thesis (Ph.D.)--University of Western Sydney, 2007. / A thesis presented to the University of Western Sydney, College of Health and Science, School of Nursing, in fulfilment of the requirements for the degree of Doctor of Philosophy. Includes bibliographies.

Thesis (M.A.)--Northern Kentucky University, 2008. / Made available through ProQuest. Publication number: AAT 1454299. ProQuest document ID: 1588784891. Includes bibliographical references (p. 26-28)

Thesis (Ph. D.)--West Virginia University, 2009. / Title from document title page. Document formatted into pages; contains xiv, 157 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 110-121).

Thesis (M.H.A.)--University of Michigan, 1957.