MCur / Department of Advanced Nursing Science / Se the attached abstract below

<p>Aim: To establish whether a family centered approach to HIV care in which HIV positive adults are counseled on the importance of having their children tested results in the adults bringing their children under the age of five years for testing and or accessing HIV care, and to explore challenges faced by caregivers in bringing children for testing and care.</p>

<p>Aim: To establish whether a family centered approach to HIV care in which HIV positive adults are counseled on the importance of having their children tested results in the adults bringing their children under the age of five years for testing and or accessing HIV care, and to explore challenges faced by caregivers in bringing children for testing and care.</p>

Magister Public Health - MPH / Aim: To establish whether a family centered approach to HIV care in which HIV positive adults are counseled on the importance of having their children tested results in the adults bringing their children under the age of five years for testing and or accessing HIV care, and to explore challenges faced by caregivers in bringing children for testing and care. / South Africa

Sammanfattning Bakgrund Varje år nyinsjuknar ca 300 barn i cancer vilket påverkar hela familjens vardag. Barnen längtar efter den normala vardagen och det är viktigt att föräldrarna och barnet får information och kunskap om sjukdomen. Barn ska vara delaktiga i sin vård och barnsjuksköterskas uppgift är att skapa en långvarig relation där bemötandet är nyckeln till relationen. Syfte Att beskriva barns (3-8 år) och deras föräldrars erfarenheter av barnsjuksköterskans bemötande inom barnonkologisk omvårdnad 36 månader efter diagnostillfället. Metod Studien är kvalitativ med intervju som datainsamlingsmetod. En deduktiv innehållsanalys enligt Elo och Kyngäs har använts där Swanssons omvårdnadsteori varit utgångspunkt. Resultatet Barnen och föräldrarna upplever trygghet när de blir vårdade av barnutbildad personal. De upplever att de har en bättre kontroll och ett bättre bemötande än de som inte är barnutbildade. De vill vara inkluderade i vården och få stöd av barnsjuksköterskan under och efter behandlingen. Föräldrar vill få information om barnets tillstånd och de vill vara engagerade i barnets omvårdnad på egna villkor. Diskussion Sjuksköterskans bemötande av barn samt föräldrar är viktigt vid barn onkologisk omvårdnad. Barnsjuksköterskans kunskap vid bemötande av barnet och familjen har stor betydelse och barnutbildad personal är önskvärt av föräldrarna. Barnsjuksköterskor behöver förstå hur barnen och deras familjer upplever vården och vilka behov de har både under och efter behandling för att främja hälsa och välbefinnande.

The life of a preterm infant admitted to a neonatal intensive care unit may be stressful from the moment of birth. Ever since Hans Selye’s initial characterisation of the biological stress response, cortisol has been frequently measured as an indicator of stress responsivity. However, research of the stress response and cortisol in infants, especially those who are preterm and/or ill, has been scarce basically because of methodological issues. The first aim with this thesis was to investigate the acute stress response, as measured by salivary cortisol and behaviour, for preterm infants, healthy infants, and infants at high psychosocial risk in response to certain defined handling procedures. The second aim was to investigate the stress response, as measured by salivary cortisol and psychometric measures, for parents present during the handling procedure of their infants. The intention was to perform all investigations in an as naturally occurring situation as possible, which means that the studied procedures would have been performed irrespectively of the research. The present thesis includes six original articles. The results of the first study demonstrate that it is feasible to collect sufficient amounts of saliva and to analyse salivary cortisol in neonates using the presented method of collection and analysis. The second study shows that preterm infants, usually cared for in incubators, show no signs of discomfort and have variable cortisol responses during skin-to-skin care with their mothers. The mothers, however, experience stress and low control before their first skin-to-skin care with their preterm infant and do not relax completely until after the session. In the third study we found that preterm infants have higher baseline salivary cortisol as compared to healthy full-term infants. Moreover, preterm infants have higher and sustained pain response during a nappy change as compared to healthy full-term infants. The results of the fourth study shows that infants younger than three months, living in psychosocial high-risk families, have increased cortisol responses during a nappy change, performed by the mother. However, support with the aim of improving mother-infant interaction, dampens the stress response. The results of the fifth study show that oral sweet-tasting solution in combination with a pacifier dampen the levels of the stress hormone cortisol in three months old infants during routine immunisation. Moreover, parents experience more self-rated emotional stress before immunisation if it is their first child who is being immunised. The sixth paper shows that the material used for saliva collection (cotton buds with wooden or plastic sticks) is of importance when saliva is collected but for practical reasons not centrifuged within 24 hours prior to cortisol analyse. The present thesis shows that it is practically feasible to collect saliva and to analyse the stress hormone cortisol in infants. The interpretation of infants’ and parents’ salivary cortisol responses to different handling procedures are discussed in relation to shortand long-term consequences, neonatal intensive care, preterm birth, attachment, mood, and pain.

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: There is no formal succession plan for paediatric professional nurses (PNs) in academic, tertiary hospitals in the Western Cape. A lack of a succession plan could have major implications for the sustainability of effective and efficient health care services (Department of Health, DoH, 2010:1). Therefore, a systematic scientific investigation is required to determine the opinions of PNs regarding the characteristics or criteria for a succession plan in a paediatric organization. The aim of this study was to determine the opinions of paediatric PNs regarding succession or career planning in academic, tertiary hospitals in the Western Cape. A quantitative approach with an exploratory, descriptive, non-experimental design was applied by means of a questionnaire survey which consisted of closed and openended questions. Reliability and validity were assured by means of a pilot study and consultation with nursing experts and a statistician. Cronbach’s alpha test was used to test for internal consistency between the responses to the 3-point Likert scale and dichotomous questions on the characteristics of an ideal succession plan. The data was collected by means of a self-administered, structured questionnaire to elicit opinions regarding the characteristics of an ideal succession plan that includes a career plan. Ethical approval was obtained from the Health Research Ethics Committee of the University of Stellenbosch. Permission for access to the hospitals was obtained from the hospital and nursing managers. Informed written consent was obtained from the participants. The questionnaires were distributed personally by the researcher at two hospitals and via the assistant manager in nursing at one hospital. Data was analysed by the statistician and descriptive statistics were presented by means of frequency distribution tables and histograms. Furthermore, the existence of relationships between variables was compared by means of a t-test or when assumptions of the t-test were not fulfilled an appropriate non-parametric test was considered. The results were evidence of the need for the development of a succession plan based on Benner’s Novice to Expert Model for paediatric PNs in academic, tertiary hospitals in the Western Cape. In addition, participants’ opinions on the value of a succession plan, including a career plan showed multiple benefits that will outweigh its challenges once developed and implemented. Recommendations are based on the scientific evidence that show the urgent need for the development and implementation of a formal five level skill-based clinical training programme that includes a 360-degree feedback system for paediatric PNs by means of an integrated, collaborative approach. The development and implementation of a formal succession plan will strengthen and enhance the retention of the various levels of competent, proficient and expert paediatric PNs. In addition, a formal succession plan will attract and motivate the novice and advance beginners to progress to competent, proficient and expert levels. / AFRIKAANSE OPSOMMING: Daar is geen formele opvolgplan vir pediatriese professionele verpleegpersoneel in akademiese tersiêre hospitale in die Wes-Kaap nie. ’n Gebrek aan ’n opvolgplan kan ernstige gevolge vir die volhoubaarheid van effektiewe en doeltreffende gesondheidssorgdienste inhou (DoH, 2010:1). Dus, is ’n sistematiese wetenskaplike ondersoek nodig om die opinies van professionele verpleegpersoneel te bepaal, ten opsigte van die eienskappe of kriteria vir ’n opvolgplan in ’n pediatriese organisasie. Die doel van hierdie studie was om die opinies van pediatriese professionele verpleegpersoneel te bepaal ten opsigte van ’n opvolg- of beroepsplan in akademiese, tersiêre hospitale in die Wes-Kaap. ’n Kwantitatiewe benadering met ’n ondersoekende, beskrywende, nie-eksperimentele ontwerp is toegepas deur gebruik te maak van ’n vraelysopname wat bestaan het uit geslote en ope-vrae. Betroubaarheid en geldigheid is verseker deur gebruik te maak van ’n loodsondersoek en raadpleging van verpleegkundiges en ’n statistikus. Cronbach se alpha-toets is gebruik om te toets vir interne konsekwentheid tussen die response tot die 3-punt Likertskaal en tweeledige vrae oor die kenmerke van ’n ideale opvolgplan. Die data is gekollekteer deur gebruik te maak van ’n selfgeadministreerde, gestruktureerde vraelys om opinies te onthul ten opsigte van die kenmerke van ’n ideale opvolgplan, wat ’n beroepsplan insluit. Etiese goedkeuring is verkry van die Gesondheidsnavorsing se Etiese Komitee van die Universiteit van Stellenbosch. Toestemming vir toegang tot die hospitale is verkry van die hospitaal en verpleegbestuurders. Ingeligte skriftelike toestemming is van die deelnemers verkry. Die vraelyste is persoonlik versprei deur die navorser by twee hospitale en via die assistentbestuurder wat by een van die hospitale verpleeg. Data is geanaliseer deur die statistikus en beskrywende statistiek is aangebied by wyse van frekwensie verspreidingstabelle en histogramme. Voorts, is die bestaan van verwantskappe tussen veranderlikes vergelyk, deur gebruik te maak van ’n ttoets of waar veronderstellings van die t-toets nie bereik is nie, is ’n gepaste nieparametriese toets oorweeg. Die resultate is bewys van die behoefte vir die ontwikkeling van ’n opvolgplan wat gebaseer is op Benner se Novice to Expert Model vir pediatriese professionele verpleegpersoneel in akademiese, tersiêre hospitale in die Wes-Kaap. Daarbenewens, het deelnemers se opinies die waarde van ’n opvolgplan wat ’n beroepsplan insluit, die veelvoudige voordele wat dit inhou getoon wat die uitdagings sal oortref, sodra dit ontwikkel en geïmplementeer word. Aanbevelings is gebaseer op die wetenskaplike bewys wat dui op die dringende behoefte vir die ontwikkeling en implementering van ’n formele vyfvlak vaardigheidsgebaseerde kliniese opleidingsprogram wat ’n 360-grade terugvoersisteem insluit vir pediatriese professionele verpleegpersoneel deur middel van ’n geïntegreerde, medewerkende benadering. Die ontwikkeling en implementering van ’n formele opvolgplan sal die retensie van die verskeie vlakke van bekwame, vaardige en kundige pediatriese professionele verpleegpersoneel versterk en bevorder. Boonop sal ’n formele opvolgplan nuwelinge en gevorderdes trek en motiveer om te ontwikkel tot bekwame, vaardige en kundige vlakke.

Thesis (Mcur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: A literature study showed that the topics of medication safety and medication error prevention have been studied in depth. Findings from the literature revealed that medication errors are reported to be common in neonatal and paediatric ICUs, that more than half of these errors are preventable and that risk reduction measures protect patients against untoward outcomes or adverse events (Clifton-Koeppel, 2008:72). If and when there is a failure in the process of safe medication administration, it results in a medication error, which is defined as a breach of one or more of the five rights of medication administration (Institute for Safe Medication Practices Alert, 2007:1). Medication administration, which is predominantly a nursing task, is of high risk and high volume in the intensive care unit (ICU). The accuracy of intravenous medication administration is critical for a neonatal and paediatric ICU patient since it can potentially heighten the patient’s vulnerability if further harm is caused. In view of the complexity of medication administration for neonatal and paediatric ICU patients, researchers confirm the diverse role of the registered nurse in safe medication administration practices. The purpose of the study was to describe the perceptions of registered nurses (RNs) regarding the factors that influence IV medication safety practice in the neonatal intensive care unit (NICU); paediatric intensive care unit (PICU); and paediatric cardiac intensive care unit (CSICU) in Saudi Arabia. The study objectives were set to describe the actual factors that have an influence on IV medication safety practices of RNs working in these ICUs; to determine the knowledge of registered nurses in the selected ICUs with regard to safe intravenous medication administration practices and to describe nursing medication administration strategies that are focused on medication error prevention. A quantitative research approach was selected for this study which had a descriptive, survey design. An 85% non-probability purposive sampling method was used to draw a sample (n=103) of the target population of NICU-, PICU- and CSICU-registered nurses (N=121) who were responsible for administering intravenous medication at King Faisal Specialist Hospital and Research Centre in Jeddah (KFSHRC-J). A self-administered questionnaire with closed-ended Likert and open-ended question was designed to describe the objectives under study. A pilot study was conducted to pre-test the questionnaire. A quantitative method was used to analyse the study data. MS Excel was used to capture the quantitative data after which it was analysed using descriptive statistics by means of STATISTICA 9 software. The open–ended questions (indicating “other” and Question 70) were also interpreted quantitatively after exploring the main aspects in the responses. The main findings were that multiple perceived factors influence the intravenous medication safety practices of RN’s working with neonatal and paediatric ICU patients in a particular Saudi Arabian tertiary hospital. It was found that these nurses’ had knowledge regarding safe medication administration practice that constitutes that all five medication rights have to be checked through nursing ‘double-checks’ in the steps of medication administration, as the method of checking as per hospital policy. However, from the findings, it is reflected that RNs perceptions of completely and correctly checking medication rights through complete and independent nursing ‘double-checks’, do not match the steps required by policy and that their knowledge is inadequate. It is evident from the perceptions of RNs that they are aware of the multiple factors influencing IV medication safety practice in this vulnerable patient setting. As perceived by RNs, it is possible to implement more safety strategies. Key recommendations on conclusion of the study include that there are more nursing medication administration strategies that could still be implemented for medication error prevention. These strategies relate to medication safety awareness, the role of the nurse and nursing managers, mandatory staff education, and review of knowledge and skills. / AFRIKAANSE OPSOMMING: Gebaseer op ʼn literatuurstudie blyk dit dat medikasieveiligheid en voorkoming van medikasiefoute reeds in diepte bestudeer are. Bevindings dui daarop dat medikasiefoute algemeen voorkom in neonatale en pediatriese intensiewesorgeenhede, dat meer as die helfte daarvan voorkombaar is, en dat maatreëls om risiko te vermindering pasiënte teen voorkombare uitkomste beskerm (Clifton-Koeppel, 2008:72). Indien en wanneer die proses vir veilige medikasietoediening faal, kom ʼn medikasiefout voor, wat gedefinieer word as die verbreking van een of meer van die vyf medikasieregte (Institute for Safe Medication Practices Alert, 2007:1). Medikasietoediening is hoofsaaklik ʼn verpleegtaak, wat ʼn hoërisiko- en hoëvolume-taak behels. Die akkuraatheid van intraveneuse medikasietoediening is kritiek vir neonatale en pediatriese intensiewesorgpasiënte, aangesien hul weerloosheid verhoog word indien verdere skade veroorsaak word. Omrede medikasietoediening vir neonatale en pediatriese intensiewesorgpasiënte kompleks is, bevestig navorsers dat geregistreerde verpleegkundiges se rol ten opsigte van veilige medikasietoediening veelsoortig is. Die doel van die studie was om die persepsies van geregistreerde verpleegkundiges aangaande die faktore wat medikasieveiligheid in die neonatale en paediatriese intensiewe eenhede in Saoedi-Arabië beinvloed, te beskryf. Studiedoelwitte is gestel om die spesifieke faktore te beskryf wat aanleiding gee tot medikasietoedieningsfoute in die genoemde intensiewesorgeenhede; om geregistreerde verpleegkundiges in die geselekteerde intensiewesorgeenhede se kennis van veilige medikasietoediening te bepaal; en die medikasietoedieningstrategieë wat op die voorkoming van medikasietoedieningsfoute fokus, te beskryf. ʼn Kwantitatiewe navorsingsbenadering is geselekteer vir die studie wat ʼn beskrywende navorsingsontwerp gehad het. ʼn 85% nie-waarskynlike gerieflikheidsteekproef is gebruik om ʼn steekproef (n=103) te selekteer vanuit die teikenpopulasie geregistreerde verpleegkundiges (N=121) wat verantwoordelik was vir medikasietoediening in die geselekteerde intensiewesorgeenhede by King Faisal Specialist Hospital and Research Centre, Jeddah (KFSHRC-J). ʼn Self-geadministreerde vraelys met geslote Likert- en oop-eindevrae is opgestel om die gestelde studiedoelwitte te ondersoek. ʼn Vooraf-toetsing van die vraelys is tydens die loodsstudie uitgevoer. ʼn Kombinasie van kwantitatiewe en kwalitatiewe metodes is gebruik vir die ontleding van die studie-data. Die kwantitatiewe data is op MS Excel ingevoer, waarna beskrywende statistiek deur middel van Statistica 9-sagteware gebruik is om dit te ontleed. Die studie het hoofsaaklik bevind dat veelvuldige faktore die veiligheidspraktyk ten opsigte van intraveneuse medikasie van geregistreerde verpleegkundiges wat met neonatal en pediatriese intensiewesorgpasiënte in ʼn spesifieke tersiêre hospitaal in Saoedi-Arabië werk, beïnvloed. Dit blyk dat hierdie verpleegkundiges se kennis voldoende is aangaande ‘n veilige medikasie toedieningspraktyk wat bestaan uit die kontrolering van al vyf medikasieregte deur verpleegkundige dubbel-kontrolering, soos beskryf is in die hospitaalbeleid. Volgens die bevindinge blyk dit egter dat die verpleegkundiges se persepsie van volledige and korrekte verpleegkundige dubbel-kontrolering, nie met die stappe volgens die hospitaalbeleid ooreenstem nie en dat hulle kennis onvoldoende is. Dit is duidelik dat die verpleegkundiges bewus is van die veelvuldige faktore wat intraveneuse medikasieveiligheidpraktyk vir weerlose pasiënte beïnvloed. Die verpleegkundiges se persepsie is dat daar meer verpleegkundige medikasietoedieningstrategieë is wat geïmplementeer kan word om medikasiefoute te voorkom, insluitende veiligheidsbewustheid ten opsigte van medikasie, die rol van verpleegkundiges en verpleegbestuurders, verpligte personeelopleiding, en hersiening van kennis en vaardighede.

Background: The effectiveness of inhaled salbutamol in routine care depends particularly on prescribed dosage and applied inhalation technique. To achieve maximum effectiveness and to prevent drug-related problems, prescription and administration need to work in concert. Methods: We performed a controlled intervention pilot study with 4 consecutive groups in a general paediatric unit and assessed problems in salbutamol prescribing and administration. Control group [i]: Routine care without additional support. First intervention group [ii]: We carried out a teaching session for nurses aimed at preventing problems in inhalation technique. Independently from this, a pharmacist counselled physicians on problems in salbutamol prescribing. Second intervention group [iii]: Additionally to the first intervention, physicians received standardised feedback on the inhalation technique. Follow-up group [iv]: Subsequently, without any delay after the second intervention group had been completed, sustainability of the measures was assessed. We performed the chi-square test to calculate the level of significance with p ≤ 0.05 to indicate a statistically significant difference for the primary outcome. As we performed multiple testing, an adjusted p ≤ 0.01 according to Bonferroni correction was considered as significant. Results: We included a total of 225 patients. By counselling the physicians, we reduced the number of patients with problems from 55% to 43% (control [i] vs. first intervention [ii], n.s.). With additional feedback to physicians, this number was further reduced to 25% ([i] vs. [iii], p < 0.001). In the follow-up [iv], the number rose again to 48% (p < 0.01 compared to feedback group). Conclusions: Teaching nurses, counselling physicians, and providing feedback on the quality of inhalation technique effectively reduced problems in salbutamol treatment. However, for success to be sustained, continuous support needs to be provided. Trial registration: German Clinical Trials register: DRKS00006792.

Children and adolescents are thought to use oxidative metabolism to a greater extent than adults during high intensity exercise. The studies reported in this thesis examine the nature and implications of age-related differences in muscle metabolism during high intensity exercise and recovery. Chapter 4 concluded that during heavy intensity exercise, phosphocreatine (PCr) kinetics did not differ with age or sex, while Chapter 5 revealed that during very heavy intensity exercise, the fundamental τ was slower and slow component amplitude greater in men compared with adolescent boys, indicating that exercise intensity might play a role in determining age-related differences in muscle metabolism. In Chapter 6, two bouts of very heavy intensity exercise were completed, and prior exercise reduced the PCr slow component amplitude in men but not boys. Deoxyhaemoglobin (HHb) kinetics was faster in adolescents compared with adults during both heavy and very heavy intensity exercise, indicating that matching of oxygen delivery to oxygen utilisation is less precise at the onset of exercise in adolescents compared with adults. PCr recovery from high intensity exercise was faster in boys than men, but not different in girls and women, as described in Chapter 7. The speed of PCr recovery was correlated with maturity in adolescents, but was not correlated with end-exercise [PCr] or pH. Two different tests to measure mitochondrial capacity in adolescents were evaluated in Chapter 8, and a fitted curve and gated test were both used to determine PCr recovery kinetics. Finally, in Chapter 9, age-related differences in muscle metabolism and oxygenation during fatiguing exercise were examined; a strong trend for greater fatigue in adults compared with adolescents was accompanied by greater metabolic perturbation in adults. Overall, these data show that muscle metabolism and oxygenation differs between adolescents and adults during and following very high intensity exercise.