Barriers to implementation of evidence-based practices in a critical care unit
- Authors: Bowers, Candice Andrea
- Date: 2013
- Subjects: Evidence-based medicine , Critical care medicine , Nursing ethics
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10048 , http://hdl.handle.net/10948/d1013612
- Description: Over the last three decades there has been a greater need for health care practitioners to base their decision on the best available in order to optimise quality and cost-effective patient care. Evidence-based practice necessitates guideline development, education and review in order to achieve improved patient outcomes. However, initiatives that endeavour to disseminate and implement evidence-based practice have faced barriers and opposition. Barriers that might hamper the implementation of evidence-based practice include characteristics of the evidence itself, personal, institutional or organizational factors. The research study explored and described the barriers to implementation of evidence-based practices in a critical care unit. Based on the data analysis, recommendations were made to enhance the implementation of evidence-based practices in the critical care unit. A quantitative, explorative, descriptive and contextual research design was used to operationalize the research objectives. The target population comprised professional nurses in the critical care unit. Non-probability sampling was used to obtain data by means of a structured self-administered questionnaire. Descriptive data analysis was applied, using a statistical programme and the aid of a statistician. The results are graphically displayed using bar graphs and tables. Recommendations for nursing practice, education and research were made. Ethical principles have been maintained throughout the study.
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- Date Issued: 2013
Endotracheal tube verification in the mechanically ventilated patient in a critical care unit
- Authors: Fataar, Danielle
- Date: 2013
- Subjects: Respirators (Medical equipment) , Critical care medicine , Intensive care units
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10020 , http://hdl.handle.net/10948/d1008057 , Respirators (Medical equipment) , Critical care medicine , Intensive care units
- Description: Critically ill patients often require assistance by means of intubation and mechanical ventilation to support their spontaneous breathing if they are unable to maintain it. Mechanical ventilation is one of the most commonly used treatment modalities in the care of the critically ill patient and up to 90% of patients world-wide require mechanical ventilation during some or most parts of their stay in critical care units Management of a patient’s airway is a critical part of patient care both in and out of hospital. Although there are many methods used in verifying the correct placement of the endotracheal tube, the need and ability to verify placement of an endotracheal tube correctly is of utmost importance, because many complications can occur should the tube be incorrectly placed. Since unrecognized oesophageal intubation can have many disastrous effects on patients, various methods for verifying correct endotracheal tube placement have been developed and considered. Some of these methods include direct visualization, end-tidal carbon dioxide measurement and oesophageal detector devices. This research study aimed to explore and describe the existing literature on the verification of endotracheal tubes in the mechanically ventilated patient in the critical- care unit. A systematic review was done in order to operationalize the primary objective. Furthermore, based on the literature collected from the systematic review, recommendations for the verification of the endotracheal tube in the mechanically ventilated patient in the critical care unit were made. Ethical considerations were maintained throughout the study and the quality of the systematic review was ensured by performing a critical appraisal of the evidence found.
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- Date Issued: 2013
Experiences of professional nurses with regard to accessing information at the point-of-care via mobile-computing devices at a public hospital
- Authors: Benjamin, Valencia
- Date: 2013
- Subjects: Information storage and retrieval systems -- Hospitals , Point-of-care testing , Public hospitals -- Medical staff
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10060 , http://hdl.handle.net/10948/d1020193
- Description: Mobile computing devices are capable of changing how healthcare is delivered in the future, since they aim to merge and integrate all services into one device that is versatile, customisable, and portable. The aim of this study was to explore and describe the experiences of professional nurses with regard to accessing information at the point-of-care of the patient, in order to develop guidelines that could assist other professional nurses with implementing the mobile computing device for accessing information at the point-of-care of patients. To achieve the purpose of the study, a qualitative, explorative, descriptive, and contextual design was used to conduct this research – to gain an understanding of how the professional nurses experienced accessing information at the point-of-care via mobile computing devices. The study was conducted among the professional nurses employed at the public hospital, who were trained and provided with the mobile computing device for accessing information at the point-of-care for more than two years. In-depth interviewing was conducted to obtain the data. Data analysis was done using Tesch‘s method to make sense out of text and data. Four themes were identified, namely, the professional nurses‘ expression of various experiences regarding the training received; the need for support in implementing the mobile computing device; the accessing of information at the point-of-care as beneficial for educational purposes; and the accessing of information at the point-of-care as beneficial to patient care. Two main guidelines were developed. The study concludes with recommendations made with regard to the areas of nursing practice, education and research. Throughout the study, the researcher abided by the ethical considerations. The aspects of trustworthiness implemented in this study, included dependability, credibility, transferability and confirmability (Holloway & Wheeler, 2010:298).
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- Date Issued: 2013
Guidelines for a therapeutic programme to address the mental health needs of adolescents being treated in a psychiatric hospital
- Authors: Smith, Lourett
- Date: 2013
- Subjects: Teenagers , Psychiatric hospitals , Mental health facilities
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10036 , http://hdl.handle.net/10948/d1010963 , Teenagers , Psychiatric hospitals , Mental health facilities
- Description: It is estimated that about 10 million children and adolescents worldwide, annually suffer from psychiatric disorders. They often require hospital treatment because they are not coping with their psychiatric condition at home or there is a lack of supervision. Suicide amongst adolescents who are experiencing a crisis is a bleak reality. In-patient treatment provides the necessary structure and supervision in order to secure a stable environment which is vital for treating adolescents. Treatment usually includes a therapeutic programme provided by members of the multi-professional team. Since there is at present no adolescent in-patient treatment facility in the Nelson Mandela Bay to provide psychiatric care to adolescents who are experiencing a mental problem, these patients are admitted to psychiatric hospitals which cater only for the needs of adult patients or they are referred to facilities in other provinces. The goals and objectives of this study are firstly, to explore and describe the perceptions of mental health professionals working in psychiatric hospitals regarding what should be included in a therapeutic programme for adolescents and secondly, to develop guidelines for treating adolescents that can be implemented in psychiatric hospitals in the Nelson Mandela Bay. The study followed a qualitative, exploratory, descriptive, contextual design. The research population included various professionals who provide services at psychiatric hospitals in the Nelson Mandela Bay. Purposive sampling was utilized. Semi-structured interviews were conducted to collect information-rich data and field notes were kept. The interviews were transcribed and Tesch’s eight steps of data analysis were followed to create meaning from the data collected. Themes were identified and grouped together to form new categories. An independent coder assisted with the coding process to ensure the trustworthiness of the findings. Literature was reviewed in order to identify research that was done previously regarding adolescent psychiatric in-patient programmes in order to bridge the gaps that were identified. The researcher ensured the validity of the study by conforming to Lincoln and Guba’s model of trustworthiness which consists of the following four constructs, namely, credibility, transferability, dependability and confirmability. The researcher ensured that the study was conducted in an ethical manner by adhering to ethical principles such as beneficence, justice and fidelity.
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- Date Issued: 2013
Nursing care practice related to patient safety in the operating room
- Authors: Theron, Margot Cecile
- Date: 2013
- Subjects: Operating room nurses -- South Africa -- Port Elizabeth , Nursing ethics -- South Africa -- Port Elizabeth , Nurse and patient -- South Africa -- Port Elizabeth
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10051 , http://hdl.handle.net/10948/d1017197
- Description: Patient safety is a primary concern of members of the surgical team. Professional nurses working in the operating room play a vital role in the safety of the patients from the moment the patient enters the operating room to the discharge of the patient to the unit. Quality nursing care is of the utmost importance and therefore it is the responsibility of a professional nurse to ensure patient safety during the peri-operative period. Team work and good communication in the operating room are essential in order to ensure patient safety. Nursing care practices related to patient safety should be a key aspect to consider in rendering care to the surgical patient and professional nurses should perform their duties to the best of their ability despite lack of resources and shortage of staff. The main purpose of the study was to explore and describe nursing care practice related to patient safety in the operating room at hospitals in the Nelson Mandela Metropolitan area. Once this was established recommendations on how to enhance nursing care practice related to patient safety in the operating room were made. This study is based on a quantitative, explorative, descriptive and contextual design. Convenient sampling was used in this study. Data were collected by means of a self-administered questionnaire. Descriptive and inferential statistics were used to analyse the data. Ethical considerations were adhered to and the findings of the research will be disseminated appropriately. Recommendations based on the findings that emerge from the data, as well as the literature review, will be offered to enhance nursing care practice related to patient safety in the operating room.
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- Date Issued: 2013
Respiratory management of the mechanically ventilated spinal cord injured patient in a critical care unit
- Authors: Love, Janine Ann
- Date: 2013
- Subjects: Respirators (Medical equipment) , Critical care medicine , Intensive care units , Spinal cord -- Wounds and injuries
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10031 , http://hdl.handle.net/10948/d1008451 , Respirators (Medical equipment) , Critical care medicine , Intensive care units , Spinal cord -- Wounds and injuries
- Description: Background: Spinal Cord Injuries (SCIs) are traumatic, life-changing injuries that can affect every aspect of an individual's life and can lead to death if not treated timeously and appropriately. Respiratory complications occur frequently after the SCI and are the leading cause of mortality and morbidity. Respiratory complications are predictable based on the neurological level of impairment of the spinal cord lesion; the higher the neurological injury, the more severe the respiratory complication. Changes in pulmonary function, poor cough, hypersecretion, immobility and bronchospasm all contribute to the development of respiratory complications. If the patient is unable to protect his/her airway or if respiratory failure occurs, mechanical ventilation is often required. Many patients require prolonged ventilation and subsequently need to go for tracheostomies. The critical care nurse plays an important role in the early identification of complications and can, therefore, act to limit and prevent these complications, which may be a direct result from the injury or treatment modality such as mechanical ventilation. Respiratory management has been promoted in preventing and treating respiratory complications and is associated with better prognosis in the SCI patient. Design and method: The research study aims to explore and describe existing literature and to make recommendations for the respiratory management of a mechanically ventilated spinal cord injured patient in a critical care unit (CCU). A systematic review was undertaken with clear inclusion and exclusion criteria. Ethical principles were maintained throughout the study. The quality of the study was ensured by critically appraising data that was utilized in the systematic review. It is envisaged that the results from this systematic review will improve the respiratory management of the SCI patient and prevent any variations in practice. Results: Were presented under the following themes: priorities of care for the SCI patient in the acute phase, during the critical care phase and preventative care. Conclusion: The SCI patient regardless of the neurological level or completeness of injury should be admitted to the CCU for intensive ventilatory, cardiopulmonary support and hemodynamic monitoring in order to detect and prevent respiratory complications. The use of larger tidal volumes is associated with improved comfort and less dyspnea however if a patient has acute lung injury or ARDS the use of low tidal volumes 6ml/kg is recommended. Prevention and early identification of respiratory complications is associated with improved outcomes for the SCI patient.
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- Date Issued: 2013
The lived experiences of professional nurses with regards to end-of-life issues in the Intensive Care Unit
- Authors: Clifford, Ilzé
- Date: 2013
- Subjects: Intensive care units , Death
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10055 , http://hdl.handle.net/10948/d1018572
- Description: Professional nurses working in an intensive care unit (ICU) are faced with the death of critically ill patients frequently. Modern day medicine and technology have made it possible for advanced life-sustaining measures to be implemented on patients who, without medical intervention, would otherwise not have survived. The question is raised: is modern technology preserving life and prolonging the dying process, or is it in the best interest of the patient for treatment to be withdrawn? Nurses, caring for these patients and their families, are practicing at the bedside of these dying patients and are thus often faced with end-of-life issues, particularly withdrawal of treatment. The primary functions of critical care nurses are toward their patients. Physicians are responsible for making decisions regarding withdrawal of treatment. However, the nurses in the ICU are responsible for implementing the decisions made; sometimes contradicting what they believe in. The experience of end-of-life issues, namely withdrawal of treatment, is a cause of distress for the professional nurse. Little research has been done on how the ICU nurses deal with end-of-life issues and what support structures are required to assist nurses in dealing with end-of-life issues (Hov, Hedelin & Athlin, 2006:204) The objectives of the study were to explore and describe the professional nurses‟ lived experiences of end-of-life issues in the intensive care unit. The study aimed to make recommendations regarding support strategies to assist professional nurses in dealing with end-of-life issues in the intensive care unit. The researcher has selected a qualitative research approach with an explorative, descriptive and contextual design in order to conduct the study. Data was collected by means of semi-structured interviews. Data was analysed using the steps as illustrated by Tesch‟s method. Ethical principles were maintained throughout the research study. The findings of this study are to be presented in a journal publication.
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- Date Issued: 2013