Driven by research studies and national targets, sedation practices in Intensive care Units (ICU) are undergoing change. Traditionally, ventilated patients in ICUs were kept deeply sedated and only gradually ‘weaned off’ sedation. However, current evidence supports a more ‘wakeful’ patient with the introduction of ‘sedation holds’ encouraging them to regain consciousness (Kress et al. 2000). There is little research exploring ICU nurses’ assessment and management of sedation. Employing a Heideggerian, hermeneutic phenomenological approach to enquiry, the study sought to provide insights into the world of the critical care nurse, nursing with technology, and specifically their beliefs surrounding sedation practices and how organisational factors, knowledge and personal experiences influence their clinical decisions in the care of the ventilated patient. The setting was the Royal Infirmary of Edinburgh, ICU and the purposive sample consisted of 16 ICU nurses with diverse critical care nursing experience. Bedside interviews, utilising an aide memoir, elicited narratives about the nurses’ experiences of sedation practice and a novel sedation monitor (responsiveness). The phenomenological analysis drew upon a number of existing frameworks to guide enquiry. The researcher engaged with the ‘hermeneutic circle’, acknowledging her pre-understandings and using these as a platform to move between the whole of the research and the parts, the descriptions and narratives offered, to develop new knowledge. Themes emerged that demonstrated patients’ sedation status directly impacted upon the nurses’ ICU lived experiences and left them in a state of disequilibrium regarding the requirement to deliver research based care, the desire to deliver holistic care and the duty to deliver safe care. The nurses perceived sedation holds and ‘wakefulness’ as resulting in patient agitation and distress which affected patient safety and comfort. However, the nurses equally felt a pressure of obligation to the doctors to perform such evidence based sedation holds. They described the struggling to maintain patient safety and manage their own fears and anxieties and organisational constraints, whilst experiencing guilt, blame and failure associated with their behavioural discordance with the prescribed decisions and their own clinical decision making processes and strategies. Team work between the two professions and effective leadership is evidently less than ideal. Consequently the implementation of changes in sedation practice is failing to meet either the national targets or to respond to the nurses’ concerns regarding their patient’s short term wellbeing. On both counts this potentially impairs the pursuit of best practice.

M.Sc.(Nursing), Faculty of Health Sciences, University of the Witwatersrand, 2012 / The purpose of this study was to describe family members’ opinions regarding the quality of care and decision-making in the adult intensive care units. A quantitative descriptive research design was utilized to meet the study objectives. Structured interviews were conducted using the FS-ICU (24) questionnaire with participants (family members, n=100) drawn from three intensive care units. Descriptive and comparative statistics were used to analyse the data. Satisfaction with care was rated by family members’ as higher than their satisfaction with decision-making. Overall 91.0% (n=91) of family members’ were mostly satisfied with the care provided. Of the 24 items the management of patient symptoms was the most highly rated items. The least satisfied item related to the waiting room, which was rated as 93.0% (n=93) dissatisfactory. Frequency of communication, completeness of information, feeling excluded and unsupported during decision-making and the rigid visiting hours were areas identified for improvement in the ICU. These findings suggest that deficiencies exist in meeting family’ needs. Based on the research findings, it can be concluded that results of this study have supported the existing evidence in literature from previous studies on family satisfaction with care and decision-making in the ICU. Recommendations for nursing practice, education, research and institution are proposed.

Nursing in the contemporary Australian healthcare system, particularly in speciality areas, is acknowledged as a highly stressful and difficult undertaking. A range of factors has contributed to this situation including changes in staffing levels, patient acuity, resourcing of the healthcare system and nurse recruitment and retention. A number of studies on the intensive care environment have identified factors that cause stress and role strain in nurses. Other research has explored the coping mechanisms these nurses implement to manage work stresses. To date, no Australian studies have sought to provide an encompassing explanation of why and how nurses choose to remain working in this challenging area of practice. This study seeks to develop one possible explanation for this phenomenon. Grounded theory was selected as the most appropriate means of achieving this aim. It explores behavioural patterns and how these develop into interactive social processes. Grounded theory investigates and reveals how people manage problematic life situations, enabling emergence of a substantive theory, which is grounded in context and situation dependent research data. This research study was undertaken in three intensive care units in one area health service in New South Wales. The constant comparative analysis method was used, revealing that nursing in the intensive care environment is a stimulating, challenging experience, which at times is also frustrating and demoralising. The emergent substantive theory was titled “Traversing the path of the intensive care nursing experience”. This study achieves two objectives. It adds to the accumulated knowledge base related to intensive care nursing by offering an explanation of why and how these specialist nurses remain practising at the bedside. It substantiates the results from previous research that investigated stressors and stress management in nursing within the intensive care environment. There are a number of implications for nursing education, research and practice that can be drawn from this study. Impacting on all levels of nursing, these include the development of effective stress management, interpersonal communication techniques, recognition of competence and its assessment, and conflict mediation and management. Further research is needed into understanding nurses’ self-concept and the effect of the working environment on the delivery of effective nursing practice. / Master of Science (Hons.)

Thesis (MCur. (Faculty of Health Sciences))--University of Pretoria, 2006. / Includes bibliographical references.

Thesis (Ph. D.)--University of Texas at Austin, 2001. / Vita. Includes bibliographical references (leaves 405-423). Available also in a digital version from Dissertation Abstracts.

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Purpose: The purpose of this study was to identify the stressors that affecting the critical care nurses in Abu Dhabi hospitals in order for the managers to take action to decrease or control these stressors where possible, or to take other appropriate action. Design: A cross sectional survey design was adopted in this study, as the phenomena of stress in CCNs was surveyed at one point of time . Sample: A convenient sample of 50 CCNs was included in the study. The participants were working as a CCNs in Abu Dhabi hospitals for a minimum one-year. Instruments: Two questionnaires were utilized to collect the data for this study; The Critical Care Stressors Scale and The Hamilton Anxiety Scale. Results: Results showed that The CCNs did not show a high level of anxiety according to the adopted scale. The most frequent stressors perceived by the CCNs were the stressors related to the critical care unit environment and the nursing responsibilities. On the other hand, the most severe stressors perceived by the CCNs were also under the categories of the critical care unit environment and Nurse-Health care workers conflicts. Conclusion: The hospital/nursing administrations were asked to revise the policies of visiting , dealing with infectious hazards, and portable X-rays . Also, the results showed that hiring more rton-nurses staff to deal with non-nursing jobs, and more male staff to carry out the heavy jobs such as changing position will aid in decreasing the stress perceived by the CCNs. / Thesis (M.Cur.)-University of Natal, Durban, 2003.

Purpose: The of this study was to explore the knowledge, level of practice, and the frequency of problems met during the use of CTSS amongst intensive care unit (ICU) nurses and suggest ways to improve the use of the system. Design: A non experimental exploratory design using a descriptive survey approach was employed. Sample: The sample of participants were taken from three governmental hospitals in Abu Dhabi chosen randomly. It included all nurses in the ICUs of three hospitals who happened to be working at the time of the study. The response was Eighty three staff nurses, three charge nurses, and one respiratory therapist. Instrument: A questionnaire consisting of twenty one questions was used to explore the ICU nurses' knowledge, experience, practice, and difficulties met by nurses. Averages, tables, figures, and correlation coefficient were used to analyze the data. Results: Results showed a positive correlation (+0.0433) between the level of knowledge and length of use of the system but the effect is minimal. Again the knowledge and the frequency of use on ventilated patients were minimally positive (+0.0898). On the other hand, the relation between the frequency of use and the years of experience was more positively related than the frequency of use and the knowledge. Conclusion: There is a need to set a plan aiming at making the system more frequently used. Not only that , but it should be used safely and appropriately and supported by policy and procedure guidelines. / Thesis (M.Cur.)-University of Natal, Durban, 2001.