Early screening for the post intensive care syndrome in a tertiary ICU follow-up clinic in the Eastern Cape
- Authors: van der Merwe, Elizabeth
- Date: 2024-04
- Subjects: Critical care medicine , Post-traumatic stress disorder -- Patients , Psychology, Pathological
- Language: English
- Type: Doctral theses , text
- Identifier: http://hdl.handle.net/10948/63915 , vital:73626
- Description: The Post ICU Syndrome (PICS) is defined as a constellation of new or worsened impairments in physical, cognitive, and/or psychological health which persist after critical care discharge. These deficits are more related to the patients’ intensive care unit (ICU) stay rather than to their original ICU admission diagnosis. Between 25-50% of critical care survivors suffer from PICS. There is a paucity of research on PICS in South Africa (SA). The primary objective of this study is to describe the incidence and co-occurrence of PICS symptoms, as well as the changes in instrumental activities of daily living and life roles in ICU survivors.The study was conducted in a multidisciplinary tertiary ICU in the Eastern Cape. Inclusion criteria were respiratory support for ≥ 48 hours, or a shocked state, and/or organ failure requiring ICU stay for 48 hours. Patients were assessed at six weeks and six months after hospital discharge. Physical impairment was measured by the six-minute walk test and ICU-acquired weakness by the Medical Research Council scale. Instrumental activities of daily living score and employment/educational status were determined. The Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised questionnaires were used as screening tools for significant psychological symptoms. Screening for neurocognitive impairment was performed with the NeuroScreen application and compared to a matched control group. The Short Form-36 Health-Related Quality of Life questionnaire (HRQOL) was used to determine quality of life at baseline and study visits. 107 patients, half of whom had COVID-19, completed the six-month follow-up. Six months after hospital discharge, six out of ten patients were affected by PICS, five out of every ten suffered from physical impairment, four out of every ten reported significant psychological symptoms, with three out of every ten affected by both. Three out of ten experienced significant chronic pain. Overall, six out of every ten patients experienced significant psychological symptoms at either one or both study visits. Only one in ten had psychological symptoms in isolation at six months. Six out of every ten patients reported a significantly lower health-related quality of life at six months as compared to their baseline. Three out of every ten patients had not returned to their previous remunerative work, studying or home making. Neurocognitive impairment in this cohort was not verified, and this may have been due to the selection of the control group. However, there was a significant improvement in neurocognitive functioning from the six-week to the six-month study visits. Only 15% of patients received rehabilitation therapy after hospital discharge. Female sex, a higher co-morbidity score and an admission diagnosis of trauma were predictors of PICS symptoms. COVID-19 was not found to be associated with a higher incidence of PICS. , Thesis (D.Phil) -- Faculty of Health Science, School of Behavioural & Lifestyle Sciences, 2024
- Full Text:
- Date Issued: 2024-04
- Authors: van der Merwe, Elizabeth
- Date: 2024-04
- Subjects: Critical care medicine , Post-traumatic stress disorder -- Patients , Psychology, Pathological
- Language: English
- Type: Doctral theses , text
- Identifier: http://hdl.handle.net/10948/63915 , vital:73626
- Description: The Post ICU Syndrome (PICS) is defined as a constellation of new or worsened impairments in physical, cognitive, and/or psychological health which persist after critical care discharge. These deficits are more related to the patients’ intensive care unit (ICU) stay rather than to their original ICU admission diagnosis. Between 25-50% of critical care survivors suffer from PICS. There is a paucity of research on PICS in South Africa (SA). The primary objective of this study is to describe the incidence and co-occurrence of PICS symptoms, as well as the changes in instrumental activities of daily living and life roles in ICU survivors.The study was conducted in a multidisciplinary tertiary ICU in the Eastern Cape. Inclusion criteria were respiratory support for ≥ 48 hours, or a shocked state, and/or organ failure requiring ICU stay for 48 hours. Patients were assessed at six weeks and six months after hospital discharge. Physical impairment was measured by the six-minute walk test and ICU-acquired weakness by the Medical Research Council scale. Instrumental activities of daily living score and employment/educational status were determined. The Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised questionnaires were used as screening tools for significant psychological symptoms. Screening for neurocognitive impairment was performed with the NeuroScreen application and compared to a matched control group. The Short Form-36 Health-Related Quality of Life questionnaire (HRQOL) was used to determine quality of life at baseline and study visits. 107 patients, half of whom had COVID-19, completed the six-month follow-up. Six months after hospital discharge, six out of ten patients were affected by PICS, five out of every ten suffered from physical impairment, four out of every ten reported significant psychological symptoms, with three out of every ten affected by both. Three out of ten experienced significant chronic pain. Overall, six out of every ten patients experienced significant psychological symptoms at either one or both study visits. Only one in ten had psychological symptoms in isolation at six months. Six out of every ten patients reported a significantly lower health-related quality of life at six months as compared to their baseline. Three out of every ten patients had not returned to their previous remunerative work, studying or home making. Neurocognitive impairment in this cohort was not verified, and this may have been due to the selection of the control group. However, there was a significant improvement in neurocognitive functioning from the six-week to the six-month study visits. Only 15% of patients received rehabilitation therapy after hospital discharge. Female sex, a higher co-morbidity score and an admission diagnosis of trauma were predictors of PICS symptoms. COVID-19 was not found to be associated with a higher incidence of PICS. , Thesis (D.Phil) -- Faculty of Health Science, School of Behavioural & Lifestyle Sciences, 2024
- Full Text:
- Date Issued: 2024-04
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.
- Full Text:
- Date Issued: 2013
- 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.
- Full Text:
- 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.
- Full Text:
- Date Issued: 2013
- 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.
- Full Text:
- 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.
- Full Text:
- Date Issued: 2013
- 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.
- Full Text:
- Date Issued: 2013
Professional nurses' knowledge regarding weaning the critically ill patient from the mechanical ventilation
- Authors: Demingo, Xavier Preston
- Date: 2011
- Subjects: Artificial respiration , Respiratory therapy , Critical care medicine , Respirators (Medical equipment) , Artificial respiration -- Nursing
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10026 , http://hdl.handle.net/10948/1323 , Artificial respiration , Respiratory therapy , Critical care medicine , Respirators (Medical equipment) , Artificial respiration -- Nursing
- Description: Mechanical ventilation (MV) is one of the most frequently used treatment modalities in the intensive care unit (ICU) (Burns, 2005:14). Up to 90% of critically ill patients in ICUs globally are connected to a mechanical ventilator. Although mechanical ventilation is a lifesaving intervention, it is expensive and is associated with diverse complications (Mclean, Jensen, Schroeder, Gibney & Skjodt, 2006: 299). Ventilator-associated pneumonia (VAP) accounts for 25% of all infections in ICU, with global crude mortality figures estimated at 20-70% (Craven, 2006:251). Minimising the time that a patient is connected to a mechanical ventilator to the absolute minimum can have considerable benefits in terms of decreased mortality and morbidity, as well as a decreased length of ICU stay and lower hospital costs. Critically ill patients therefore need to be weaned from the mechanical ventilator as soon as their condition that warranted the need for mechanical ventilation is stabilized. The process of weaning the critically ill patient from mechanical ventilation constitutes a significant proportion of total ventilator time. As professional nurses attend to the mechanically ventilated patient 24 hours a day, they have a vital role to play in the collaborative management of the patient requiring weaning from mechanical ventilation. The objectives of this study were to explore and describe the professional nurses’ knowledge regarding weaning the critically ill patient from mechanical ventilation. Based on the results, recommendations in the form of a protocol were made in order to improve the professional nurses’ knowledge and enhance the care of the mechanically ventilated patient. A quantitative design, which was exploratory, descriptive and contextual in nature, was utilised for the study. The data collection instrument of choice was a self-administered questionnaire. Convenience, non-probability sampling was the sampling method chosen for the purpose of this study. Collected data were analysed with the assistance of a statistician using descriptive and inferential statistics. Results were displayed in the form of graphs and tables. The results obtained in the study, combined with data from the literature review, were used to develop recommendations to enhance vi professional nurses’ knowledge regarding weaning the critically ill patient from mechanical ventilation. The recommendations were presented in the form of a protocol based on the available evidence. Ethical principles as they relate to conducting research were adhered to throughout the study.
- Full Text:
- Date Issued: 2011
- Authors: Demingo, Xavier Preston
- Date: 2011
- Subjects: Artificial respiration , Respiratory therapy , Critical care medicine , Respirators (Medical equipment) , Artificial respiration -- Nursing
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10026 , http://hdl.handle.net/10948/1323 , Artificial respiration , Respiratory therapy , Critical care medicine , Respirators (Medical equipment) , Artificial respiration -- Nursing
- Description: Mechanical ventilation (MV) is one of the most frequently used treatment modalities in the intensive care unit (ICU) (Burns, 2005:14). Up to 90% of critically ill patients in ICUs globally are connected to a mechanical ventilator. Although mechanical ventilation is a lifesaving intervention, it is expensive and is associated with diverse complications (Mclean, Jensen, Schroeder, Gibney & Skjodt, 2006: 299). Ventilator-associated pneumonia (VAP) accounts for 25% of all infections in ICU, with global crude mortality figures estimated at 20-70% (Craven, 2006:251). Minimising the time that a patient is connected to a mechanical ventilator to the absolute minimum can have considerable benefits in terms of decreased mortality and morbidity, as well as a decreased length of ICU stay and lower hospital costs. Critically ill patients therefore need to be weaned from the mechanical ventilator as soon as their condition that warranted the need for mechanical ventilation is stabilized. The process of weaning the critically ill patient from mechanical ventilation constitutes a significant proportion of total ventilator time. As professional nurses attend to the mechanically ventilated patient 24 hours a day, they have a vital role to play in the collaborative management of the patient requiring weaning from mechanical ventilation. The objectives of this study were to explore and describe the professional nurses’ knowledge regarding weaning the critically ill patient from mechanical ventilation. Based on the results, recommendations in the form of a protocol were made in order to improve the professional nurses’ knowledge and enhance the care of the mechanically ventilated patient. A quantitative design, which was exploratory, descriptive and contextual in nature, was utilised for the study. The data collection instrument of choice was a self-administered questionnaire. Convenience, non-probability sampling was the sampling method chosen for the purpose of this study. Collected data were analysed with the assistance of a statistician using descriptive and inferential statistics. Results were displayed in the form of graphs and tables. The results obtained in the study, combined with data from the literature review, were used to develop recommendations to enhance vi professional nurses’ knowledge regarding weaning the critically ill patient from mechanical ventilation. The recommendations were presented in the form of a protocol based on the available evidence. Ethical principles as they relate to conducting research were adhered to throughout the study.
- Full Text:
- Date Issued: 2011
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