Thesis submitted in fulfillment of the requirements for the degree of Masters of Science
in Nursing, Faculty of Community and Health Sciences, Department of Nursing Education,
University of the Witwatersrand
Johannesburg, 2012 / Studies generally agree the survival of the mechanically ventilated patient in the ICU is
largely reliant upon the competence of the nurse undertaking this highly specialized role
(Alphonso,Quinones,Mishra,et al. 2004; Burns 2005) However, an audit undertaken by
the Critical Care Society of Southern Africa (2004) revealed that 75 % of nurses working
in ICU are inexperienced and do not hold an ICU qualification, and as such are unlikely
to have acquired the level of competency required to care for the mechanically ventilated
patient (Binnekade 2004). A high index of suspicion exists around the competence levels
of nurses‟ currently working in ICU in SA as revealed by local studies (Khoza & Ehlers
1998; Scribante & Bhagwanjee 2003; Moeti, van Niekerk, van Velden, 2004; Morolong &
Chabeli 2005; Windsor 2005; Perrie & Schmollgruber 2010).
The purpose of the study was to determine and describe the level of competence with
regard to mechanical ventilation, of nurses working in ICU, who have varying years of
experience and training backgrounds, using study specific designed clinical vignettes, in
two tertiary healthcare institutions in Gauteng.
A descriptive two phase design was utilized for the study. Phase one comprised the
development and validation of three clinical vignettes to determine the level of
competence of nurses working in ICU‟s with regard to mechanical ventilation. A modified
Delphi technique technique using purposively sampled experts from medical technical
and nursing backgrounds was used to validate the three clinical vignettes. Content
validity was strengthened by computing CVI of the instrument. In Phase two consecutive
sampling was used, and data collection comprised of participants (n=136) completing
three validated clinical vignettes in the ICU‟s of two tertiary healthcare institutions in
Gauteng. All nurses who participated in the study completed the same three clinical
vignettes and demographic data. Nurses‟ perceptions regarding their own level of
competence with regard to mechanical ventilation were quantified and compared with
actual scores achieved in the clinical vignettes.
Descriptive and inferential statistics were used to analyse the data. The level of
significance was set at <0,05 and confidence levels at 95%. The competency indicator
for the vignettes was set at 75% by the expert group, and nurses‟ level of competence
was graded according to vignette score outcomes using a grading scale. Statistical
assistance was obtained from a statistician from the Medical Research Council (MRC).
Results: Results of the study showed that nurses regardless of training background,
age, or experience showed a poor level of knowledge, the average score being 48% for
ICU qualified nurses and 31% for non-ICU qualified nurses. There was a small significant
difference between ICU qualified and non-ICU qualified nurses‟ competence levels in
mechanical ventilation when analysed using a two tailed- t- test (p=0.039). Nurses also
experienced a misperception regarding their own competence levels in mechanical
ventilation when compared to their actual competence levels as determined by three
clinical vignettes.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/13114 |
| Date | January 2012 |
| Creators | Botha, Margaret Lynn |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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