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Fisher, Joyce Ann. "Critical thinking in critical care nurses." Virtual Press, 1996. http://liblink.bsu.edu/uhtbin/catkey/1036181.
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Critical care nurses need finely honed critical thinking skills in order to be safe, competent, and skillful practitioners of their profession. If clinical nurses do not learn how to reason effectively, they may make inappropriate decisions about their patients' care, ultimately resulting in increased patient mortality (Fonteyn, 1991). In addition, increasing nurses' decision-making and autonomy has been shown to improve job satisfaction and retention (Prescott, 1986).There are many authors who write about the need for developing critical thinking skills among practicing professional nurses (Creighton, 1984; Jenkins, 1985; Levenstein, 1981, 1983, 1984). However, research assessing the impact of continued education and clinical experience on the development of critical thinking skills is sparse.The purpose of this exploratory study is to determine if there is a relationship between the level of critical thinking skills (as measured by the Watson-Glaser Critical Thinking Appraisal Tool, 1980) in critical care nurses and the length of nursing experience, amount of continuing education pursued annually, and the level of formal nursing education completed. The conceptual framework that provides the basis for this study is Patricia Benner's (1984) application of the Dreyfus Model of Skill Acquisition to clinical nursing practice.Participants (N = 61) were obtained on a voluntary basis from the population of critical care nurses working in the intensive Care Unit, Coronary Care Unit, Cardiac Catheterization Laboratory, or Emergency Care Center of a 600 bed midwestern acute care facility. Each participant in the study was asked to sign an informed consent agreeing to participate after receiving a written and oral explanation of the study. Confidentiality of the participants was maintained by substituting identification numbers for the subjects' names on the data collection instruments. The investigator supervised the administration of the critical thinking instrument and demographic questionnaire.The Pearson product-moment correlation coefficient and a two-tailed t-test for independent samples were used to determine if there were any significant relationships between the WGCTA score and the length of critical care experience, attendance of continuing education programs, or completion of additional formal education. This data analysis supported hypothesis one with the results revealing a significant positive correlation (r = .46, p = <.001) between the WGCTA scores and the length of critical care experience. In addition, a statistically significant but weak positive correlation was found between the WGCTA scores and the length of experience in CCU (r = .52, p = .001). No significant correlation existed between the WGCTA scores and length of experience in ECC, ICU, or CCL. Hypothesis two was supported with a significant difference (t = 3.58, df = 59, p = .001) found between the critical thinking ability of the two groups, with those who have completed an additional formal program of nursing education scoring higher. A significant but weak positive correlation (r = .30, p =.020) was found between the number of continuing education programs attended annually and the WGCTA scores. Multiple regression was performed with the total WGCTA score being the dependent variable and total critical care experience, completion of additional formal education, and attendance of continuing education programs being the independent variables. Only total critical care experience entered the equation (E = 16.03, p = <.001) explaining 21% of the variance.The information gained from this study will provide direction for the review of existing orientation, continuing education, and staff development programs provided at different levels of nursing experience and make suggestions for change to enhance critical thinking skill development.School of Nursing
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Alasad, Jafer A. "A phenomenology of critical care: The lived experience of critical care nurses." Thesis, University of Manchester, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.487878.
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This study investigates the experiences of twenty-two critical care nurses in an attempt to uncover the essential elements in the practice of critical care nursing. The study is grounded in the phenomenological hermeneutics of Martin Heidegger and argues that this methodology is compatible with the humanistic values of nursing. Data were generated from in-depth interviews and overt participant observation. The process of data analysis was guided by Heidegger's notions of phenomenological reflection and hermeneutic circle, Van Manen's (1990) process of thematic analysis and Draper's (1997) analytical principles. Five themes have been identified from the data. These are: (1) 'managing technology' which describes the nurse's relationship with the technological environment of the intensive care unit (2) 'communication with the patient which discusses the nurses' concern regarding the communication needs of the sedated and unconscious patient (3) 'deciding' which explores the decision-making process incorporated by the nurses and draw the attention to the nurses' involvement in ethical decisions (4) 'Humanising care' which describes the humanistic practices that the nurses implement in order not to lose sight of the patient's individual human identity (5) 'coping' which describes some of the situations and dilemmas facing the nurses in the unit with special concern to death as a source of stress and anxiety. The study concluded with an attempt to describe the ontological qualities of the study themes by drawing on Heidegger's concepts of care, involvement, being-in-the-world, understanding, death and his idea regarding our relationship with the technology. When viewed from Heideggerian perspective all the entities in the critical care unit are unified by the concepts of care and involvement which are considered the basic way of being-in-the-world as a critical care nurse. Finally the study suggests some practice and research possibilities.
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Engström, Åsa. "Close relatives of critically ill persons in intensive and critical care : the experiences of close relatives and critical care nurses." Licentiate thesis, Luleå tekniska universitet, Omvårdnad, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-18362.
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The aim of the licentiate thesis was to describe close relatives of critically ill persons within intensive and critical care from the perspective of close relatives and of critical care nurses. The data were collected by means of qualitaive research interviews with seven partners of persons who had been critically ill and cared for in an intensive care unit, and with focus groups discussions with 24 critical care nurses. The data were then analysed using a qualitative thematic content analysis.This study shows it was a frightening experience to see the person critically ill in an unknown environment. It was important to be able to be present; nothing else mattered. Showing respect, confirming the integrity and dignity of the ill person were also essential. recieving support from family and friends was important, as were understanding what had happened, obtaining information and the way in which this was given. The uncertainty concerning the outcome of the ill person was hard to cope with. Close relatives wanted to feel hope, even though the prognosis was poor.The presence of close relatives was taken for granted by critical care nurses and ut was frustrating if the ill person did not have any. Information from close relatives made it possible for critical care nurses to create personal care for the critically ill person. Critical care nurses supported clsoe relatives by giving them information, being near and trying to establish good relationships with them.Close relatives were described as an important and demanding part of the critical care nurses' work something that took time and enegy to deal with, and the critical care nurses missed forums for discussions about the care given.The discussion of this study show the importance for close relatives to be near and advocate for the ill person. Feeling that staff care about the ill person and close relatives make close relatives to feel safe. Recieving explanations to understand what as happening is significant.Godkänd; 2006; 20061212 (andbra)
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Duffy, M. J. "Endothelial dysfunction in critical care." Thesis, Queen's University Belfast, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.546047.
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Thomson, Sam J. "Liver dysfunction in critical care." Thesis, St George's, University of London, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.546794.
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Hughes, Felicity. "Relatives' experiences of critical care." Thesis, University of Surrey, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.421320.
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Hodkinson, Peter William. "Developing a patient-centred care pathway for paediatric critical care in the Western Cape." Doctoral thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/17259.
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Includes bibliographical referencesBackground: Emergency care of critically ill or injured children requires prompt identification, high quality treatment and rapid referral. This study examines the critical care pathways in a health system to identify preventable care failures by evaluating the entire pathway to care, the quality of care at each step along the referral pathway, and the impact on patient outcomes. Methods: A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation until paediatric intensive care unit admission or emergency centre death, using a modified confidential enquiry process of expert panel review and caregiver interview. Outcomes were expert panel assessment of quality of care, avoidability of death or PICU admission and severity at PICU admission, identification of modifiable factors, adherence to consensus standards of care, as well as time delays and objective measures of severity and outcome. Results: The study enrolled 282 children: 85% medical and 15% trauma cases (252 emergency admissions, and 30 children who died at referring health facilities). Global quality of care was graded poor in 57(20%) of all cases and 141(50%) had at least one major impact modifiable factor. Key modifiable factors related to access and identification of the critically ill, assessment of severity, inadequate resuscitation, delays in decision making and referral, and access to paediatric intensive care. Standards compliance increased with increasing level of healthcare facility, as did caregiver satisfaction. Children presented primarily to primary health care (54%), largely after hours (65%), and were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 74% of children, indicating room for improvement. Conclusions and Relevance: The study presents a novel methodology, examining the quality of paediatric critical care across a health system in a middle income country. The findings highlight the complexity of the care pathway and focus attention on specific issues, many amenable to suggested interventions that could reduce mortality and morbidity, and optimize scarce critical care resources; as well as demonstrating the importance of continuity and quality of care throughout the referral pathway.
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Hendricks, Lucia Elizabeth. "Critical thinking : perspectives and experiences of critical care nurses." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71821.
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Thesis (MCurr)--Stellenbosch University, 2012.ENGLISH ABSTRACT: The increasingly complex role of the critical care nurse in an intensive care environment demands a much higher level of critical thinking and clinical judgment skill than ever before. Critical thinking in nursing practice may be defined as the cognitive ability to analyse, predict and transform knowledge, ensuring quality nursing care. To reason from a nurse’s perspective requires that we learn the content of nursing; this includes the concepts, ideas and theories of nursing. The aim and objectives of the study were to explore critical care nurses’ perspectives and experiences with regards to the concept of critical thinking, facets influencing the application of critical thinking skills in clinical practice and how these impact on the delivery of quality nursing care. A qualitative approach, using a case study design was utilised. A sample of six participants, who met the study inclusion criteria and consented to participate, were interviewed individually. Subsequently, five of these six participants took part in a focus group discussion to capture additional data to clarify and enrich the individual interview data. A field worker was present during the interviewing processes to note non-verbal data and later verify transcribed data. Feasibility of the proposed study was established by conducting a pretest which elicited relevant information. Ethical approval for the study was obtained from the Health Research Ethics Committee at the Faculty of Medicine and Health Sciences, Stellenbosch University. Permission and consent was obtained from the relevant hospital group to interview nurses working in the intensive care units. Qualitative content analysis, which focuses on the content or contextual meaning, was used to analyse interview data. Coding of the data through emergent themes and sub-themes was done by the researcher and supported through independent coding to verify and strengthen the analysis and interpretation of the researcher. . The results depicted how the participants personally understood the concept of critical thinking and the components influencing the application of critical thinking skill in clinical practice. The study of the participants’ perspective of the concept of critical thinking and portrayed how they experience analytical and independent thinking, competence and confidence, as well as knowledge, skill and expertise, to influence the quality of patient care. The data revealed several themes that facilitated critical thinking in critical care nurses. These themes were ‘team support’, ‘experience and exposure’ and ‘empowering the mind’. Emergent themes elaborating the limitations of critical thinking included ‘being stressed’, ‘professional boundaries’ and ‘being busy’. Several recommendations and suggestions for future research were offered.
AFRIKAANSE OPSOMMING: Die toenemende komplekse rol van die kritieke-sorgverpleegster in ’n intensiewe-sorg omgewing verg ’n veel hoër vlak van kritiese denke en ’n kliniese oordeelvaardigheid as ooit tevore. Kritiese denke in ’n verplegingspraktyk kan gedefinieer word as die kognitiewe vermoë om te kan analiseer, om vooruit situasies te kan bepaal en die vermoë om kennis te omskep sodat kwaliteit verpleegsorg verseker kan word. Om soos ’n verpleegster te kan dink, stipuleer dat die inhoud van verpleging geleer moet word wat konsepte, idees en teorieë daarvan insluit. Die doel en oogmerke van die studie is om die ervarings en perspektiewe van kritieke-sorgverpleegsters te ondersoek, met betrekking tot die konsep van kritiese denke, fasette wat die toepassing van kritiese denkvaardighede in ’n kliniese praktyk beïnvloed en die impak daarvan op die lewering van kwaliteit verpleegsorg. Die metodologie wat toegepas is, is ’n kwalitatiewe benadering deur middel van ’n gevalle-studie ontwerp. ’n Steekproefgrootte van ses deelnemers wat aan die inklusiewe kriteria voldoen het, is mee onderhoude individueel gevoer en daarna is met vyf van hierdie ses deelnemers in ’n fokusgroep onderhoude gevoer ten einde data op te neem wat andersins verlore kon geraak het. ’n Veldwerker was teenwoordig gedurende die proses van onderhoudvoering om die opgeneemde en getranskribeerde data te verifieer. Die data-insamelingsinstrument is in die vorm van ’n onderhoudsgids ontwikkel om die navorser gedurende die onderhoudvoering te help. ’n Loodsondersoek is uitgevoer om die haalbaarheid van die voorgestelde studie te ondersoek en is sodoende geskep om relevante inligting te onthul. Etiese goedkeuring vir die studie is verkry van die Gesondheidsnavorsing Etiese Komitee aan die Fakulteit van Geneeskunde en Gesondheidswetenskappe, Universiteit Stellenbosch. Goedkeuring en toestemming is van die hospitaalgroep aan wie die hospitaal behoort verkry, waar die studie onderneem is om sodoende onderhoude te kan voer met verpleegsters wat in die intensiewe-sorgeenhede werk. ’n Primêre, kwalitatiewe inhouds analise is gebruik om omderhoud data te analiseer wat fokus op die inhoud of kontekstuele betekenis daarvan. Kodering van die data deur die toepassing van die temas en sub-temas wat voorgekom het, is deur die navorser gedoen. Die data is onafhanklik gekodeer om die analise en interpretasie van die navorser te verifieer en te bekragtig ten einde die akkuraatheid en getrouheid in die formulering van die betekenis en interpretasie van gebeure met juiste weergawe daarvan, te verseker. Die resultate wat as hooftemas vanuit die individuele onderhoude voortgespruit het, asook die van die fokusgroep het die deelnemers se eie begrip van die konsep van kritiese denke en komponente wat die toepassing van kritiese denkvaardigheid in ’n kliniese praktyk beïnvloed, getoon. Die konsep van kritiese denke het die wyse waarop analitiese en onafhankilke denke, bevoegdheid en selfvertroue, asook kennis, vaardigheid en kundigheid die kwaliteit van pasiëntsorg beïnvloed, uitgebeeld. Die voortkomende data het daartoe aanleiding gegee dat die faktore wat die fasilitering en beperking van kritiese denke beïnvloed, bespreek kon word. Data rakende fasilitering het getoon hoedat die ondersteuning van die span, ervaring, blootstelling en die verruiming van die gees, kritieke-sorgverpleegsters positief kan beïnvloed om kritiese denke in hulle daaglikse verplegingsaktiwiteite effektief te kan toepas. Data wat verband hou met beperkings het getoon hoedat stres, professionele kwessies en besigwees kritieke-sorgverpleegsters negatief kan beïnvloed in die toepassing van kritiese denke gedurende daaglikse verplegingsaktiwiteite. Verskeie aanbevelings vir toekomstige navorsing is voorgestel.
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Jeddian, Alireza. "Is critical care service relevant to Iran's hospital care?" Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/5486/.
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The numbers of acutely ill patients (AIP) are admitted in general hospital wards increased. The failing to identify, manage and deliver timely and optimal care to AIPs may lead to catastrophic outcomes. A qualitative study aimed to define the current state of AIPs in Iranian hospitals showed the flaws and shortcomings in the current services for identifying and managing AIPs. An evaluation study was designed to explore the potential impact of Critical Care Service (CCS) in an Iranian University Hospital. The study design was a Stepped-Wedge Cluster Randomized Controlled Trial. The study included, for each ward, an unexposed to the intervention, training, and an exposed to the intervention phase. The data was analyzed using three methods: all patients, matched randomized and before-after. The null-hypothesis was tested using the mixed effect logistic regression, linear mixed and the mixed effects models. The results showed that there are no significant differences in mortality, CPR, ICU admission and length of stay. A second qualitative to find the views of staffs toward the CCS indicated that the CCS had several favorable effects, however; overcoming contextual problems in the hospital, prior to implementation of CCS, may facilitate its implementation.
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Currey, Judy A., and mikewood@deakin edu au. "Critical care nurses' haemodynamic decision making." Deakin University. School of Nursing, 2003. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20050728.094123.
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For cardiac surgical patients, the immediate 2-hour recovery period is distinguished by potentially life-threatening haemodynamic instability. To ensure optimum patient outcomes, nurses of varying levels of experience must make rapid and accurate decisions in response to episodes of haemodynamic instability. Decision complexity, nurses characteristics, and environmental characteristics, have each been found to influence nurses' decision making in some form. However, the effect of the interplay between these influences on decision outcomes has not been investigated. The aim of the research reported in this thesis was to explore variability in critical care nurses' haemodynamic decision making as a function of interplay between haemodynamic decision complexity, nurses' experience, and specific environmental characteristics by applying a naturalistic decision making design.
Thirty-eight nurses were observed recovering patients in the immediate 2-hour period after cardiac surgery. A follow-up semi-structured interview was conducted. A naturalistic decision making approach was used. An organising framework for the goals of therapy related to maintaining haemodynamic stability after cardiac surgery was developed to assist the observation and analysis of practice. The three goals of therapy were the optimisation of cardiovascular performance, the promotion of haemostasia, and the reestablishment of normothermia. The research was conducted in two phases. Phase One explored issues related to observation as method, and identified emergent themes. Phase Two incorporated findings of Phase 1, investigating the variability in nurses' haemodynamic decision making in relation to the three goals of therapy.
The findings showed that patients had a high acuity after cardiac surgery and suffered numerous episodes of haemodynamic instability during the immediate 2-hour recovery period. The quality of nurses' decision making in relation to the three goals of therapy was influenced by the experience of the nurse and social interactions with colleagues. Experienced nurses demonstrated decision making that reflected the ability to recognise subtle changes in haemodynamic cues, integrate complex combinations of cues, and respond rapidly to instability. The quality of inexperienced nurses' decision making varied according to the level and form of decision support as well as the
complexity of the task. When assistance was provided by nursing colleagues during the reception and recovery of patients, the characteristics of team decision making were observed. Team decision making in this context was categorised as either integrated or non integrated. Team decision making influenced nurses' emotions and actions and decision making practices. Findings revealed nurses' experience affected interactions with other team members and their perceptions of assuming responsibility for complex patients.
Interplay between decision complexity, nurses' experience, and the environment in which decisions were made influenced the quality of nurses' decision making and created an environment of team decision making, which, in turn, influenced nurses' emotional responses and practice outcomes. The observed variability in haemodynamic decision making has implications for nurse education, nursing practice, and system processes regarding patient allocation and clinical supervision.
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Xie, Hui. "The sound environment in critical care." Thesis, University of Sheffield, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.555221.
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It has been widely accepted that noise levels in hospitals are typically higher than the guidelines. This research aims to systematically investigate the sound field in critical care environment, develop the prediction models, and explore the acoustic effects on patients and staff. The Critical Care Units at two local NHS hospitals have been selected for case studies. Three core categories with plenty of interactions were identified by means of grounded theory for the acoustic environment, namely 'time-dependant sounds', 'role-dependant people' and 'departmental-dependant space', and the improvement strategies are limited but possible. Through a series of acoustic measurement, a diffuse field could be approximately assumed in the single-bed and multi-bed wards. The sound levels measured in the wards for each night are in excess of the WHO guided values by at least 20d8A. For both wards and U-shaped long corridor, if the relevant simulation parameters were set up appropriately, the agreement between measured and simulated RT as well as SPL is satisfactory, suggesting the feasibility of computer simulation for such spaces. A database comprised of quadratic equations was established with a good accuracy (±2.5d8) to predict the sound propagation along the U-shaped long space applicable to various geometric sizes. An effective observation method was designed for noise behaviour in the healthcare environment. Amongst the observed noise sources, talking was identified with the largest number of occurrences, shortest interval and the longest duration, followed by the monitor's alarm. Lognormal distribution was determined as the most appropriate statistical distribution for noise behaviours. Finally, an agent-based acoustic model was developed to integrate noise behaviours with the acoustic parameters. It is capable of replicating the complex and dynamic acoustic environment (±2dBA) as well as conducting what-if analysis. Two noise maps were produced to determine the noise sensitive areas, which would be useful to assist the decision making upon noise actions.
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Blakemore, Amy. "Insulin sensitivity tools for critical care." Thesis, University of Canterbury. Mechanical Engineering, 2009. http://hdl.handle.net/10092/2606.
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Stress induced hyperglycaemia is prevalent in critical care. Since the landmark paper published by Van den Berghe et al. (2001) a great deal of attention has been paid to intensive insulin therapy in an ICU setting to combat the adverse effects of elevated glucose levels and poor glycaemic control. Glycaemic control protocols have been extensively developed, tested and validated within an ICU setting. However, little research has been conducted on the effects of a glycaemic
control protocol in a less acute ward setting. There are many additional challenges presented in a ward setting, such as the variation in meals and levels of activity between patients, from day to day and throughout the day.
A simple compartment model is used to describe the nature of insulin and
glucose metabolism in patients of the Cardiothoracic Ward (CTW). A stochastic
model of the fitted insulin sensitivity parameter is generated for this cohort
and validated against cohorts of similar characteristics. The stochastic model is then used to run simulations of predictive control on 7 CTW patients, which shows significantly tighter glucose control than what is obtained with regular clinical procedures. However, the rate of severe hypoglycaemia is an unacceptably high 4.2%. The greatest challenge in maintaining tight glycaemic control in
such patients is the consumption of meals at irregular times and of inconsistent quantities.
Insulin sensitivity was compared to extensive hourly clinical data of 36 ICU
patients. From this data a sepsis score of value 0-4 was generated as gold standard marker of sepsis. Comparing the sepsis score to insulin sensitivity found that insulin sensitivity provides a negative predictive diagnostic for sepsis. High insulin sensitivity of greater than Si = 8 x 10⁻⁵ L mU⁻¹ min⁻¹ rules out sepsis for the majority of patient hours and may be determined non-invasively in real-time from glycaemic control protocol data. Low insulin sensitivity is not an effective
diagnostic, as it can equally mark the presence of sepsis or other conditions.
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Christensen, Martin. "Advancing practice in critical care nursing." Thesis, Bournemouth University, 2008. http://eprints.bournemouth.ac.uk/15988/.
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This thesis presents a body of publications in the area of critical care nursing, for the consideration of the award Doctor of Philosophy by publication. The publications and their dissemination herein contribute to a new and original body of knowledge within critical care nursing practice. This thesis aims to demonstrate how an original contribution to the advancement of critical care practice has developed through an on-going integration of academic and practice work and has led to the development of a model for advancing practice. Based on the know-that and know-how framework of advanced knowledge, consideration is given how this approach could be better developed to incorporate other dimensions attributed to experiential learning, namely pattern recognition and an exemplar of the knowing-how knowing-that framework is offered. However, it emerged that there are problems with advancing practice because it is considered the work of the advanced practitioner, yet it is contended that there needs to be a process which allows individuals to advance their own practice. Therefore, it was necessary to develop a working definition of advancing practice not only to map professional advancement of critical care nursing practice and how published works illustrate this, but to offer model of knowledge integration based around theoretical, practical, reflective and reflexive practice and supervisory support to enable individual practitioners the framework to advance practice. This thesis is presented in three chapters: Introduction, Body of Work and The Way Forward. In the first chapter, an overview of the origins and trends of advanced nursing practice and the emergence of advancing nursing practice in critical care. The purpose of this first section, however, is not to engage in the politico-professional debate on the meaning of advanced practice, because this is well developed within the literature, but is to set the scene in the context of published work. By using a narrative approach as a journey of personal discovery, a description of how published works illustrate progress in this respect and show the advancing of critical care practice.The second chapter not only comprises publications with regard to critical care nursing practice but also presents a detailed critique of these publications and their contribution to advancing critical care nursing practice and knowledge. Moreover this discussion identifies three themes which are further developed into the classification of knowledge attributable to advancing practice. In the concluding chapter, recommendations for the way forward are discussed with the development of a critical care nursing knowledge integration model. An exemplar of the model demonstrates that advancing practice in critical care is a continual process of development, analysis and practice that advances the knowledge and skill of critical care nursing. More importantly, it is the integration of all these facets that allows for the growth of the individual to become an advanced practitioner. In summary, this thesis represents a portfolio of work that makes an original contribution to critical care nursing knowledge. The product of this thesis is the development of a knowledge integration model as the basis for advancing practice:"
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Abelha, Fernando José Pereira Alves. "Outcome in surgical critical care patients." Doctoral thesis, Faculdade de Medicina da Universidade do Porto, 2009. http://hdl.handle.net/10216/55332.
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Skinner, Jan. "Experiencing humour: A critical care phenomenon." Thesis, Australian Catholic University, 1997. https://acuresearchbank.acu.edu.au/download/b3457ad8a05188b5584c3a400226e77870c660e60417f230e0e150924fb04dd1/1706537/Skinner_1997_Experiencing_humour_a_critical_care_phenomenon.pdf.
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Humour, whilst frequently occurring within the Critical Care environment, has been traditionally viewed as both macabre and in poor taste. However, for the Registered Nurse working in this setting, humour plays a vital role in the day to day functioning at the unit level, and is identified as an important component in the development of interpersonal relationships between both co-workers and clients. Therefore, by describing this experience, the thesis seeks to elucidate this concept of humour and the experience of this phenomenon for the Registered Nurse working within the Critical Care environment.
On reviewing the literature it becomes evident that humour is identified as conducive to both the physical and psychological wellbeing of an individual. In many ways, humour provides positive benefits in times of stress, as well as in the event of personal disillusionment and crises. Humour's role in one's daily life, as well as the recognised paucity of literature concerning the topic of humour in the area of Critical Care, and the Critical Care Unit's bent toward jocularity and play then lends itself to further exploration of this fascinating topic. Therefore, it is from this foundation that the impetus for this research thesis emerges.
The research study engages Husserlian phenomenology (Kersten, 1982) as the methodology for the explication of the meaning of humour as experienced by the Registered Nurse working within the Critical Care environment. Colaizzi's (1978) method for data analysis is employed to explicate the formulated meanings which evolve from the data. As an adjunct to this, aspects of both Bergum (1994) and Wolcott's (1990, 1994) notion of narrative storytelling of critical events, and the importance of this concept within data collection and analysis, have been incorporated within the work.
Six themes emerging from the data focus on humour as it is experienced for the participants within the study. The first of these themes identifies humour in response to the culture of the environment and is evidenced by the group's socialisation, supportive relationship and role referencing through the use of jocularity and play. The second theme emerges through the consistent use of humour in response to the event of cardiac arrests and death or dying. Registered Nurses make constant reference to the use of humour at these times as a coping mechanism, to relieve tension and support co-workers during stressful situations.
In conjunction with these two themes, the four remaining themes relate to the use of humour. Firstly is the use of humour in response to the receptiveness of other individuals. The timing and nature of humorous interplay has been described as dependent on the feedback from the recipient. Co-workers and clients alike are often tested informally as to their response when mirth is employed and the nurse gauges this response as a trigger for future interactions.
Furthermore, the use of humour as a method for communication is identified as a theme emerging from the data. Participants cite this strategy as an aid in the development of co-worker and client relationships. Communicating through humour enables life experiences to be better understood, bringing a humanness to the relationship that builds rapport and provides the basis for shared understanding between individuals. The data also outline the use of humour as a means for cheering co-workers and clients. The essence of this theme consistently weaves a path through much of the research study.
Finally, the very nature of nursing practice undertaken during the nurse's daily working life within the Critical Care Unit sets the scene for episodes of jocularity and wit. Care of the client involves the development of personal relationships whereby the nurse may perform the most intimate tasks for that individual. This milieu gives rise to the generation of humorous play that may place the client at ease during stressful and embarrassing times.
Whilst the participants' data have been analysed for the development of each theme, the thesis has then returned to the current literature for discussion. From this discussion, the implications for future nursing practice and the subsequent questions for future research have been outlined. This then paves the way for further research into the area of humour within the Critical Care environment, and indeed other settings. In conclusion, it would appear that the essence of humour as it is experienced for the Registered Nurse working within the Critical Care environment, whilst informally acknowledged, has not been well understood or explicated within the literature. Therefore, this thesis seeks to illuminate this for the reader by describing the experience of humour for the Registered Nurse working within the Critical Care Unit.
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Abelha, Fernando José Pereira Alves. "Outcome in surgical critical care patients." Tese, Faculdade de Medicina da Universidade do Porto, 2009. http://hdl.handle.net/10216/55332.
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Foley, Jo Anne. "Providing Optimal Nutrition in Critical Care." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2351.
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Malnutrition among hospitalized patients is prevalent and associated with adverse outcomes. At the health care facility for which this quality improvement (QI) initiative was developed, patients were not consistently fed within the nationally recommended 48 hours. The purpose of this project was to facilitate the early initiation of enteral feedings to prevent malnutrition in a vulnerable patient group by development of an evidence-based enteral feeding policy, algorithm, and nursing education module. The find, organize, clarify, understand, select, plan, do, check, and act model provided a systematic approach for development of the project. Validation of the QI initiative was through the use of Likert scale which was completed by 2 nurses and a head dietician. The content validity index average was 1.0 for the QI initiative products (policy, algorithm, educational module). Ten team members completed a summative evaluation of the educational module and presentation using a 7 item, Likert scale. Basic descriptive analyses were employed to analyze the data, revealing broad support for the module and the DNP student's leadership. A recommendation was made to conduct an audit using a formal software program to quantify the number of patients who were not being fed within the time frame of 48 hours. Implementing an evidence-based enteral feeding protocol can be a significant intervention that produces better patient outcomes.The implications for social change in this project relates to improvements within the critical care environment.
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Akinwolere, Oladele Augustine Odunayo. "Psychological Stress in Critical Care Nurses." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3134.
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Increased levels of stress in the workplace have led the American Psychological Association to predict a looming public health crisis. Critical care nurses (CCNs) are highly exposed to stressors in the workplace, more than other nurses. Tens of billion dollars were reported lost in productive work time yearly due to ill health from depression alone. An important gap remains in understanding the relationships of stressors with the amount of stress. Supported by the biopsychosocial stress theory, the purpose of this study was to determine the relationship between frequencies of perceived stressors (IVs) as a source of perceived levels of stress (DV) or allostasis. The mixed-methods study included an online questionnaire and an e-mail interview of 400 hospital-based CCNs from professional nurses' associations in the United States. The Nursing Stress Scale was used to determine the kinds and frequencies of IVs, while the Psychological Stress Measure was used to assess the DV. Multiple regression analysis assessed the strength and direction of the relationships between IVs and DV. Interviews fell short of the minimum sample size for saturation and were not analyzed. Quantitative findings indicated workload as the most frequently perceived stressor, correlating positively with allostasis (p = .0005). Death and dying, conflict with other nurses, and lack of support for CCNs were also statistically significant (p < .05). Implications to practice and social change include promoting changes in policy with management support to reduce workload, death and dying, conflict with other nurses, and lack of social support for CCNs. Personal behavior changes like relaxation and physical exercises as coping methods may also reduce levels stress.
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Callender, Debra. "Compassion Fatigue Among Critical Care Nurses." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7464.
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Compassion fatigue (CF), also known as secondary traumatic stress (STS), impacts critical care nurses (CCN) through exposure to pain, suffering, and loss of those for whom they provide care and results in a reduction of compassion satisfaction (CS). High incidence of CF and turnover (TO) rates at the project site were identified among CCNs. The institution's CCN TO rate was at 81% in comparison to peers in other areas at 29%â35%. The practice-focused question asked whether leadership education on CF might ameliorate CF at the project site. The purpose of the Doctor of Nursing Practice project was to reduce the incidence of CF and TO among CCN through leadership education. Watson's theory of human caring was used as a framework. Two hundred twenty-nine CCNs completed the Professional Quality of Life survey that measures CS, STS, and burnout (BO). Comparison of 28 nursing leaders' pretest scores to posttest scores indicated a statistically significant improvement (z = -4.625, p < .001) and knowledge acquisition. BO and CF taken together explained 86% (adjusted R2 = .86) of the variance in CS (F [2, 227] = 691.33, p < .001). Identifying the nursing units with the highest CF scores and providing CF education to the leadership provides a path to reduce turnover and provide needed support to CCNs, a positive social change.
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Ferrel, Cynthia Lynn. "The experience of critical care nurses in initiating hospice care." abstract and full text PDF (free order & download UNR users only), 2008. http://0-gateway.proquest.com.innopac.library.unr.edu/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1453534.
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Cowley, Nicholas John. "Point of care intravenous anaesthetic measurement in anaesthesia and critical care." Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/5127/.
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Maintenance of anaesthesia using the intravenous agent propofol has increased following development of pharmacokinetic models. An analyser capable of determining propofol concentrations at the point of care may lead to an improved accuracy of drug delivery. Validation work on a novel analyser measuring propofol concentration in near real time demonstrate a high level of precision for samples in the clinical range. Further work in the clinical setting was carried out using the novel propofol analyser to further research its potential use in a diverse patient cohort. Studies were performed in intensive care correlating blood propofol concentrations with depth of sedation, demonstrating a correlation with organ failure. The Marsh model of Target Controlled Anaesthesia was poorer at predicting propofol concentration in patients with significant organ dysfunction than in those without organ failure (correlation coefficient 0.36 vs. 0.73 respectively). Studies in the operating room were performed in which measured propofol concentrations were compared with those predicted using the Marsh model. Results demonstrated significant inaccuracies of the model (bias 32%, precision -8.7 to 72.6%). A method of Marsh model bias correction using a single blood propofol measurement was tested. Results demonstrated insufficient predictability to allow a single point calibration.
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Johnson, Stephanie Buchan. "A critical analysis of advance care planning in Australian cancer care." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/18165.
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Over the past three decades, advance care planning (ACP) programs have been widely instituted and supported by legislation in many parts of the world. The objective of this thesis is explore both the concept and the practice of ACP in the care of Australian patients with cancer. The empirical bioethics study was undertaken via three data collection strategies: 1) a systematic review of the literature regarding stakeholders’ values, perceptions and experiences of ACP, and a methodological review of existing studies which aim to assess concordance between patients’ EoL wishes and the care they receive; 2) a randomized controlled trial of an ACP intervention for patients with incurable cancer; and 3) in depth interviews with oncologists, cancer patients and their family members. The 3 phases sought to explore: what the existing empirical evidence reveals about the meaning and value of ACP to patients and their healthcare providers; the efficacy of ACP in the Australian cancer context; and what autonomy means in the context of EoL care of patients with cancer, specifically - why it is important and whether it is advanced by ACP. Drawing on the data, the conclusions of this thesis are that there are both practical and conceptual problems with ACP, and these: a) provide explanations as to why ACP may have ‘failed’ to be successfully implemented; and b) suggest that we should exercise caution in perceiving ACP as an undeniable ‘good’. Some patients may simply not want to engage in ACP, and even if they do ACP interventions may only have limited effectiveness and may only be of benefit in situations where palliative care is not accessible or integrated into routine clinical care and where there are persistent clinical commitments to aggressive care at the end of life. In addition, the concept of ACP is based upon misconstructions of what autonomy at the EoL actually means. ACP theory is overly procedural and individualistic, and a continued reliance on ‘informed decision-making’ standards as a method of supporting patient autonomy fails in important ways. It may also serve to de-privilege other important social and emotional aspects of EoL care and other important moral values.
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Chang, Catherina Ivette. "Relationship between personality hardiness and critical care nurses' perception of stress and coping in the critical care environment." FIU Digital Commons, 2000. http://digitalcommons.fiu.edu/etd/2107.
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The purpose of this study was to determine the relationship between critical care nurses' perception of stress, their ability to cope with stress, and the hardiness personality they possess while working in the critical care environment. A non-experimental, descriptive, correlational survey design was applied to a convenience sample of 50 registered nurses employed in the critical care units of a South Florida health care facility. The data collection methods included a demographic survey, the Perceived Stress Scale, the Health-Related Hardiness Scale, and the COPE inventory. The results of this study demonstrated that critical care nurses are able to cope effectively despite their perception of high levels of stress. This study also determined that critical care nurses uphold high personality hardiness characteristics. The demographic variables of gender, age, years of nursing experience, years at present job, and level of education also revealed statistical significance. Further research is recommended to identify the influence of other variables such as culture, work hours, and level of job satisfaction in the critical care nurses' coping with stress and hardiness personality. The identification of instruments that may be capable of measuring any relationships between those possible variables and the constructs of hardiness and coping in the domain of nursing are also advocated, particularly in the critical care nursing population.
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Thibault-Pervost, Jocelyne Lucie Marie. "Critical care nurses' perceptions of DNR status." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq22749.pdf.
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Comeau, Odette. "Delirium Screening in Adult Critical Care Patients." ScholarWorks, 2016. http://scholarworks.waldenu.edu/dissertations/1675.
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Delirium is an acute change in cognition accompanied by inattention, which affects up to 88% of adult critical care patients. Delirium causes increased hospital complications, longer lengths of hospital stay, functional disability, cognitive impairment, and increased mortality. The purpose of this evidence-based quality-improvement project was to implement and evaluate a delirium screening process in adult intensive care units at a large medical center. This included education of nurses, implementation of a structured, validated tool, and review of tool use documentation. The implementation of this project was guided by an evidence-based practice model, Disciplined Clinical Inquiry© and Lewin's change theory. Evaluation of this quality-improvement project used audits of the electronic medical record. The audits included the presence and accuracy of delirium screening documentation in the patients' medical records. Results of 3 sequential documentation audits revealed a gradual adoption of this practice change by nurse clinicians. The percentage of charts with missing, incomplete, or inaccurate data decreased from 50% on the first week to 27.9% and 25.0% on the 2nd and 3rd weeks, respectively. These findings were an indication of practice change by validating the requirement for delirium screening on the units. In the first 3 weeks alone, 17 patient audits were positive for delirium, indicating the potential for poor short-term and long-term patient outcomes if not addressed promptly. Implementation of delirium screening ensures the dignity and worth of adult critical care patients by decreasing the poor outcomes associated with the diagnosis, which is an important contribution to positive social change.
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Jones, Mari. "Modelling activities in a Critical Care Unit." Thesis, Cardiff University, 2008. http://orca.cf.ac.uk/54919/.
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The Critical Care Unit (CCU) is the sector of the hospital where, as the name suggests, critically ill patients receive treatment. The main aim of this research is to identify and apply suitable Operational Research techniques to model patient flow in the CCU at the University Hospital of Wales, Cardiff. The Operational Research techniques employed in this thesis include queueing theory and simulation. These methods have been utilised previously in the field of healthcare with much success. The thesis begins by considering two aspects of queueing theory, namely batch service queueing theory and batch arrival queueing theory. The latter of these is utilised to model patient flow within the CCU. Although queueing theory may be used as a good approximation to activities in the Unit, it does not incorporate all aspects of real-life. Thus discrete-event simulation is suggested as an alternative approach. Two types of statistical analysis, CART and Regression, are applied to both length of stay and mortality variables. The results from these statistical tests are compiled and investigated in more depth. Finally, a discrete event simulation model is built in Visual Basic for Applications, for Microsoft Excel. This simulation model incorporates many of the complexities of a CCU, such as patient priority and cancellation of scheduled patients if all beds on the Unit are occupied. The model is then used to test various "what-if type" scenarios, including the possibility of funding additional beds, the concept of ring-fencing of beds for different levels of care, and the likely effect of reducing the impact of bed-blocking.
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Swickard, Scott W. "Patient Safety Events During Critical Care Transport." Case Western Reserve University School of Graduate Studies / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=case1468431671.
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Allen, Rose. "Addressing moral distress in critical care nurses." NSUWorks, 2015. https://nsuworks.nova.edu/hpd_con_stuetd/17.
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Almansour, Issa Mohammad Ali. "Transitioning towards end-of-life care in Jordanian critical care units : health care professionals' perspectives." Thesis, University of Nottingham, 2015. http://eprints.nottingham.ac.uk/29464/.
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This study explored the experiences of Jordanian critical care staff about the transition to, and provision of, end of life care. It examined the difficulties they encountered, and how they sought to care for and communicate with the families of patients who were approaching the end of life. The study took place in two University hospitals in different cities. A mixed methods design in two phases was adopted. The first phase employed the “National Survey of Critical Care Nurses' Perceptions of End-of-Life Care” (adapted with permission) to elicit the views of critical care staff (N=104) about the obstacles and facilitators to providing end of life care for critically ill patients and their families. In the second phase, qualitative interviews were conducted with staff (15 nurses; 10 junior doctors; 5 head nurses). The key overarching finding from the study is that staff experience moral distress when working with critically ill patients whom they perceive to be dying. There were three main dimensions to the experience of moral distress: First, nurses experience moral distress when they are aware when the patients are likely to die, know that continuing life sustaining treatment is futile and yet are expected to continue to provide treatment as normal to the patients. Aggressive modalities of treatments are usually pursued for most terminally ill patients, with both nurses and doctors perceiving there to be no planned, clear or distinct transition from curative focused care to end of life care. Second, with regard to their relationship with patients’ families, the staff found themselves to be in a problematic and paradoxical situation. One the one hand, they expected patients’ families to take the lead in the care decision making process and perceived that the power in decision-making should lie with patients’ relatives; but on the other hand, they also perceived that it is difficult and sometimes impossible to disclose bad news openly to families meaning that families are not fully informed in a way that would enable them to take the lead in the care decision making process. Third, staff have an appreciation of the principles of end of life decision making as a team activity and as a collaborative venture, but they are not able to put these principles into practice for many reasons, ranging from difficulties in their relationships with each other to health care system factors. This study sheds light on two central ethical problems in end of life decision-making in Jordan: the problem of disclosure of terminal prognosis at the end of life and limited involvement of nurses and junior doctors in the process of end of life communication and decision making. The study recommendations focus on developing practice in and disseminating understanding of ethically sound end of life decision-making.
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Cummins, Molly. "COMMUNICATING CARE: A CRITICAL COMMUNICATION PEDAGOGY OF CARE IN THE UNIVERSITY CLASSROOM." OpenSIUC, 2014. https://opensiuc.lib.siu.edu/dissertations/809.
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The university classroom is an invaluable site for social activism. In this study, I focus on the university classroom in order to consider how university instructors care for students. More specifically, I consider what I call critical care--that is, care underscored by critical and critical communication pedagogy. I start by defining care, critical pedagogy, and critical communication pedagogy. Then, I focus on my own experiences autoethnographically to understand some of the ways I have come to understand care. After conducting interviews with teachers and those teachers' former students, I conducted dyad interviews between the teacher and the teacher's former student. I use the transcripts of these interviews as the data for an analysis of how these teachers and students understand care in their relationship. Because the teachers selected must have some background with critical and/or critical communication pedagogy, I also use the transcripts to build a case for critical care. I argue that critical care is the best way to build more humane and equitable classrooms.
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Greaves, Judith M. "Understanding palliative care: An ethnographic study of three Australian palliative care services." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2005. https://ro.ecu.edu.au/theses/1553.
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Palliative care commenced in Australia in the early 1980s. Although the value of palliative care has become more widely recognised by the public and other health care professionals, there is still a lack of understanding about what palliative care is and the depth and scope of this specialty area of health care. The research that I present in this thesis is based on examination of palliative care practice in a selection of Australian services, undertaken with the aim of enhancing understanding of Palliative Care. The significance of the research arises from the notion that members of the Australian community should be well informed about health care options available to them. Understanding palliative care and the ability to differentiate palliative care from other end-of-life care is important if people are to make informed decisions about supporting, accessing, and using services appropriate to their needs. An interpretive ethnographic study from a symbolic interactionist perspective was undertaken in three palliative care services, one in each of the major Australian cities of Sydney. Melbourne, and Perth. Each palliative care service had been established for at least ten years, and was part of a larger health care facility. A fourth service, a purpose-built three-year-old unit, was added during the course of the research to provide contrast to the emerging analyses. As an experienced palliative care nurse, I assumed the role of marginal native as the primary research instrument. Data collection was by means of participant observation, formal and informal interviews, and examination of supplementary data sources, with two months spent in each of the three study sites. Interpretations made from ethnographic observation of these Australian palliative care services showed a diversity of practice, best understood within the context of the particular service. The major findings are presented under the headings of Politics, Place, People, and Practice of Palliative Care. Common approaches to provision of care were found in creating an appropriate physical environment for patients, with an underlying mission to "make the best of things." Patients cared for in the settings were a similar cohort of middle aged to elderly cancer patients. In general, staff shared expectations of appropriate types of patients and showed discomfort or lack of understanding in caring for non-cancer patients, or patients from non-Australian, non-Christian, and non-English speaking backgrounds. Practice diversity was highlighted by the range of technology used and variations in the availability of social activities for patients in the services. These two: areas in particular warrant further research to examine the outcomes associated with these variations, in terms of survival time, quality of life, and service costs.
These findings are particularly relevant at this time when the Australian Government is attempting to enhance access to palliative care. The diversity of practice uncovered in this study suggests that discussions and decisions about allocation of resources and development of services must take into consideration the various interpretations of palliative care services that may exist. The findings also reinforce the need for sound evidence-based studies to examine the impact of variations and the types of populations that might be best served by different types of palliative care support.
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Kroeger, Linda L. "Critical care nurses: their knowledge and experiences regarding the acutely confused elderly." Thesis, Boston University, 1988. https://hdl.handle.net/2144/38058.
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Thesis (M.S.)--Boston UniversityPLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
The purpose of this descriptive study was to describe critical care nurses knowledge and experience regarding the acutely confused elderly. A questionnaire, developed by the investigator, was mailed to two hundred nurses who were members of the American Association of Critical Care Nurses (AACN). The questionnaire consisted of three parts; a case study and questions assessing the respondents' knowledge of acute confusion, questions about the respondents' past personal experiences with the elderly, and a section on demographics. The response rate was 45%. The essential findings were: 1) the mean score on the knowledge items was 60% correct 2) ICU nurses had limited personal experiences with confused elderly people 3) neither level of education nor years of nursing experience affected how well the respondents did on the knowledge items 4) ICU nurses tended to attribute the cause of acute confusion in an elderly patient to ICU psychosis. Further research needs to be done on the etiology and characteristics of acute confusion and on nursing actions and interventions concerning the acutely confused elderly patient. The concept of ICU psychosis needs to be further explored.
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Anthonie, Ramona F. G. "The experiences of critical nurses regarding staffing management in critical care units in private hospitals of the Cape Metropole." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71776.
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Thesis (MCurr)--Stellenbosch University, 2012.ENGLISH ABSTRACT: Nurse managers are responsible to staff different hospital units and departments with sufficient, trained and experienced personnel. Most critical care units in the private healthcare in South Africa are staffed below maximum workload levels and additional staff is supplemented when needed. Current staffing management strategies comprises the application of the patient acuity score, the utilisation of contracted agency staff and ward staff who assist occasionally in the critical care unit (CCU). The aim of the study was to explore the experiences of critical care nurses regarding staffing management within critical care units in private health care institutions in the Western Cape. The following objectives were set to: - explore the experiences of CCNs regarding staffing management strategies such as o the patient acuity score o the employment of ad hoc agency staff and o the utilization of ward staff A descriptive design with a qualitative approach was applied. A sample size of n=15 was drawn from a total population of N=377, using purposive sampling technique. A pilot-test was also completed. The trustworthiness of this study was assured with the use of Lincoln and Guba’s criteria of credibility, transferability, dependability and confirmability. All ethical principles were met. The findings of the study demonstrated that nurses perceive the workload in critical care units as heavy. The utilisation of the acuity score does not really assist in relieving the workload as managers tend not to consider the staffing requirements as predicted by the acuity score due to budget constraints. The enrolled nurses who assist occasionally in the critical care unit require supervision as well as ongoing development to ensure safe and quality patient care. Yet agency nurses were perceived as either extraordinary good or incompetent.
AFRIKAANSE OPSOMMING: Verpleegbestuurders het die verantwoordelik om verskillende hospitaaleenhede en departemente met voldoende opgeleide en ervare personeel te voorsien. Die meeste kritieke sorgeenhede in Suid-Afrika word met minder as dan die maksimum werkladingsvlak beman en addisionele personeel word aangevul wanneer nodig. Huidige personeelbestuurstrategieë behels die toepassing van die pasiënt akuïteit telling, die gebruik van ingekontrakteerde agentskap-personeel en saalpersoneel wat per geleentheid in die kritiekesorgeenheid help. Die doel van die studie was om die ervaringe van kritieke-sorgverpleegsters ten opsigte van personeel bestuur binne die kritiekesorgeenhede in die privaat gesondheidsorginstellings in die Weskaap, te ondersoek. Die volgende doelwitte is gestel: - Om die ervaringe van kritieke-sorgverpleegsters aangaande personeelbestuur-strategieë te ondersoek, soos: o die pasiënt akuïteit telling o die gebruik van agentskapverpleegpersoneel en o die gebruik van saal personeel, te ondersoek ’n Beskrywende kwalitatiewe studie is toegepas. ’n Steekproef van n=15 is uit ’n totale populasie van N=377 getrek deur die doelgerigte steekproeftegniek te gebruik. ’n Loodstoetsing van die semi-gestruktureerde vraelys is ook gedoen. Die betroubaarheid van hierdie studie was verseker deur van Lincoln en Guba se kriteria vir geloofwaardigheid, oordraagbaarheid, betroubaarheid en bevestigbaarheid gebruik te maak. Daar is aan alle etiese vereistes voldoen. Die bevindings van die studie toon dat die verpleegpersoneel die werklading in die kritiekesorgeenheid as veeleisend ervaar. Die aanwending van die pasiënt akuïteit-telling dra nie werklik by tot verligting van die werklading nie, aangesien bestuurders weens begrotingsbeperkings neig om nie die personeelbenodigdhede soos deur die akuïteit-telling voorspel in ag neem nie. Die ingeskrewe verpleegsters wat per geleentheid in die kritieke-sorgeenheid hulp verleen, benodig toesig asook volgehoue ontwikkeling ten einde veilige en kwaliteit pasiëntsorg te verseker. Die agentskapverpleegpersoneel is egter as baie bekwaam of onbevoeg beskou.
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Engström, Åsa. "Close relatives of critically ill persons in intensive care : the experiences of close relatives and of critical care nurses /." Luleå : Luleå University of Technology, 2006. http://epubl.ltu.se/1402-1757/2006/22/.
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Lee, Teresa M. "Family members' experiences of a critical care episode." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0019/MQ57239.pdf.
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Komenda, Izabela. "Modelling critical care unit activities through queueing theory." Thesis, Cardiff University, 2013. http://orca.cf.ac.uk/47686/.
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Critical Care Units (CCUs) are one of the most complex and expensive of all medical resources and hospital managers are challenged to meet the demand for critical care services with adequate capacity. The pressure on critical care beds is continuously increasing as new medical equipment provides the opportunity to save more patients lives. It is therefore crucial that beds are managed well and used efficiently. This thesis describes two major projects, the first undertaken in conjunction with the CCU at the University Hospital of Wales in Cardiff (UHW); and the second with two CCUs from the Aneurin Bevan Health Board. In the first project data has been analysed to determine the flow of patients through the Unit. Admissions to CCUs were categorised under two headings: emergency, and elective. The length of stay in the CCU is heavily dependent on the admission category. In this thesis, both computer simulation and theoretical queueing models have been considered, which show how improvements in bed management may be achieved by considering these two categories of patients separately. The vast majority of previous literature in this field is concerned only with steady-state conditions, whereas in reality the processes are time-dependent. This thesis goes some way to addressing this deficiency. The second project relates to work undertaken with managers from the Royal Gwent Hospital in Newport and at the Nevill Hall Hospital in Abergavenny. Data from both hospitals have been analysed to define arrival and service processes. A state-dependent theoretical queueing model has been considered which has been used to investigate the significance of combining the two units. The model has been also utilised to advise on the number of beds the new combined unit should have in order to satisfy targets quoted by the hospital managers. In the final part of the thesis, consideration has been given to the impact of collaboration, or lack thereof, between hospitals using a game theoretical approach. The effect of patient diversion has been studied. To formally investigate the impact of patients transfers, a Markov chain model of the two CCUs has been set-up, each admitting two arrival streams: namely, their own patients and transfers from other hospital. Four different models were considered and for each model the effect of targets, demand and capacity were studied. The efficiency of a system which degrades due to selfish behaviour of its agents has been measured in terms of Price of Anarchy.
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Silva, Andreia Luísa Reis da. "Emergency and critical care of the avian patient." Master's thesis, Universidade Técnica de Lisboa. Faculdade de Medicina Veterinária, 2012. http://hdl.handle.net/10400.5/3988.
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Dissertação de Mestrado Integrado em Medicina VeterináriaIncreasing numbers of exotic animals are being kept as pets and owners want to receive the same high quality veterinary medical care as given to other animals. The field of emergency and critical care is rapidly developing so this dissertation focus on clinically relevant information, some new advances and their application to therapy. In the first part of this work, the data gathered regarding all medical and surgical procedures performed during a four-month externship at Great Western Referrals Hospital, United Kingdom, under the scientific supervision of Dr. Neil Forbes is presented. The second part is a description of the most common emergency presentations, effective diagnostic and therapeutic protocols, including the pathophysiology of shock and fluid therapy. In the third part of this work, 12 clinical cases observed during the externship are presented. These cases were chosed due to their being representative of what the clinician may have to deal with in terms of avian emergency and critical care. For each case, clinical signs, diagnostic testing and treatment are described and discussed. The clinical presentation for each case is extremely diverse with inter- and intra- specific variations which is further complicated by the fact that most avian species mask signs of disease so owners are rarely aware of health problems that may occur. One of the limitations of emergency avian procedures is the challenge to reach an adequate diagnosis and establish adequate treatment protocols for critical patients, for which time is crucial. Stabilization on initial presentation is more urgent than making a definitive diagnosis and supportive care can save more exotic animals than any other treatment.
RESUMO - EMERGÊNCIA E CUIDADOS INTENSIVOS EM AVES - Cada vez mais animais exóticos são mantidos como animais de estimação e os seus donos desejam receber o mesmo nível de qualidade em termos de cuidados médico-veterinários que o prestado a outros animais. O ramo das emergências e cuidados intensivos está a desenvolver-se rapidamente sendo esta dissertação baseada em informação clinicamente relevante, avanços recentes na área e suas aplicações terapêuticas. Na primeira parte deste trabalho é apresentada informação relativa a todos os procedimentos médicos e cirúrgicos realizados durante um estágio de quatro meses no hospital Great Western Referrals, Reino Unido, sob a supervisão científica do Dr. Neil Forbes. A segunda parte contém uma descrição das apresentações clínicas de emergência mais comuns, protocolos de diagnóstico e terapia, incluindo patofisiologia do choque e fluidoterapia. Na terceira parte deste trabalho são apresentados 12 casos clínicos observados durante o estágio. Estes casos foram escolhidos como sendo representativos do que o clínico poderá encontrar em termos de emergência e cuidados intensivos de aves. Para cada caso, sinais clínicos, exames complementares e tratamento são descritos e discutidos. A apresentação clínica de cada caso é extremamente variada, com variações inter- e intra- específicas, sendo isto complicado pelo facto de que a maioria das espécies de aves escondem sinais de doença estando os seus donos raramente conscientes de problemas de saúde que possam ocorrer. Uma das limitações dos procedimentos de emergência em aves é a dificuldade em estabelecer um diagnóstico adequado com o devido protocolo terapêutico em pacientes críticos para os quais o tempo é crucial. A estabilização inicial é mais urgente do que a elaboração de um diagnóstico definitivo e um tratamento de suporte adequado pode salvar mais animais exóticos do que qualquer outro tratamento.
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Krinsky, Robin S. "Fatigue and Alarm Fatigue in Critical Care Nurses." Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1428102757.
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Baxter, Marian. ""Being certain": Moral distress in critical care nurses." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2939.
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Published literature has focused on understanding moral distress from a descriptive standpoint. Missing from the literature is an exploration of the role a nurse can play in his/her/own moral distress.A qualitative study with an interpretive design incorporated Clandinin and Connelly' narrative methodology. Results highlighted assumptions were made by participants in the absence of resources, which led them to" know the right action to take" from their own perspective.
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Trapani, Josef. "Referring in critical care : nurses as dual agents." Thesis, University of Brighton, 2014. https://research.brighton.ac.uk/en/studentTheses/9dc6a371-cf8b-40ea-ac8d-836517a1c5e5.
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Previous research has suggested that critical care nurses' close and prolonged contact with patients places them in a unique position of improving patient outcomes and reducing the demand on critical care beds by detecting subtle signs of deterioration in a timely manner and identifying patient progression and readiness for less intensive care. Nonetheless, nurses rarely take decisions about patients' treatment modalities on their own, and constantly need to seek advice or authorisation. Indeed, several studies suggested that one of the most frequent decisions taken by nurses during clinical practice is that of referring to medical, nursing or other health care practitioners. However, there is very Iim ited research around the factors related to, and the actual process of, such referring. In view of this gap in the literature, the purpose of this study was to explore and explain the process of referring in the context of an intensive care unit by means of a substantive theory derived from the data. The principal research question was: What are the factors associated with critical care nurses' decisions to seek help from medical practitioners? The study took place in a general intensive care unit in a state hospital in a Mediterranean island nation. Data generation and analysis took place concurrently and iteratively, and were guided by the dimensional analysis approach to grounded theory. Data collection involved : (1) twenty hours of preliminary non participant observation; (2) fifty hours of participant observation and informal interviewing; (3) fifteen hours of formal semi-structured interviews with ten critical care nurses working in this unit selected by means of purposive and theoretical sampling; (4) two 2-hour focus group sessions aimed at enhancing theoretical sufficiency and verification of the emerging substantive theory. The analytical process was characterised by a series of inductive-deductive cycles, during which increasingly conceptual labels were attached to data segments. Working hypotheses and theoretical memos were used to interrogate the data and look for positive and negative evidence for the inductively derived labels. The findings suggest that nurses' decisions to seek help from doctors are complex and frequently mediated by individual or organisational factors which are unrelated to the actual clinical situation, such as experience, asse11iveness and willingness to take risk. They involve nurses weighing up several occasionally conflicting motivators, including a desire to act with some degree of independence; attempting to prevent personal and professional risk; and being constantly mindful of their asymmetrical decision making power relative to doctors. A central consideration is that of balancing their moral obligation to safeguard critically ill patients' interests with their duty to respect medical practitioners' preferences. Subsequently, nurses find themselves in a position of dual agency as they need to concurrently act as an agent to two different principals, namely the medical practitioner and the patient, a situation which is potentially morally distressing. The emergent substantive theory underscores the significance of the nurse's role in acting on behalf of the patient in a scenario of significant patient vulnerability; the factors that enhance, mediate and potentially suppress this advocacy role; and the interrelatedness of nurses' relationship with doctors and their effectiveness in safeguarding critically ill patients' interests. Subsequently, the study should provide valuable insight into the type of leadership and education that is required to assist nurses in placing patients' interest at the forefront of their actions and interactions, while fostering collaboration within multidisciplinary teams.
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Johnson, Alistair E. W. "Mortality prediction and acuity assessment in critical care." Thesis, University of Oxford, 2014. https://ora.ox.ac.uk/objects/uuid:2486465e-8fda-47a9-b82e-c0a93f4f1fc4.
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Accurate mortality prediction in intensive care units (ICUs) allows for the risk adjustment of study populations, aids in patient care and provides a method for benchmarking overall hospital and ICU performance. ICU risk-adjustment models are primarily comprised of an integer severity of illness score which increases with increasing patient risk of mortality. First published in the 1980s, the improvements to these scores primarily consisted of increasing the dimensionality of the model, and hence also increasing their complexity. This thesis aims to improve upon these models. First, the field is surveyed and the major models for risk-adjusting critically ill patient cohorts are identified including the acute physiology score (APS) and the simplified acute physiology score (SAPS). A key component of model performance is data preprocessing. The effect of preprocessing ICU data is quantified on a dataset of 8,000 ICU patients, and it is shown that after preprocessing to remove extreme values a logistic regression (LR) model performed competitively (AUROC of 0.8633) with the more complex machine learning model; a support vector machine (SVM) which had an AUROC of 0.8653. For validation, model development was repeated in a larger database containing over 80,000 patients admitted to 89 ICUs in the United States. Results were similar (AUROC of 0.8895 for the LR vs 0.8917 for the SVM) but showed the performance gain when using automated outlier rejection is less pronounced in well quality controlled datasets (0.8883 for LR without rejection). It is hypothesised from this that simpler models can perform competitively with more complicated models, while having a greatly reduced burden of data collection. A severity score is developed on the large multi-center database using a Genetic Algorithm and Particle Swarm Optimisation. The severity score, named the Oxford Acute Severity of Illness Score (OASIS), is shown to outperform the APS III (AUROC 0.837 vs 0.822) and perform competitively with APACHE IV when used as a covariate in a regression model (AUROC 0.868 vs 0.881). The severity score requires only 10 variables (58% as many as APS III), reducing the burden of quality control and data collection. These variables are routinely collected in critical care by continuous monitors and do not include comorbidities, diagnosis or laboratory measurements. The severity score is then externally evaluated in an American hospital and shown to discriminate well (AUROC 0.790 vs. 0.782 for the APS III) with excellent calibration. Finally, the severity score was evaluated in an English hospital and compared to other severity scores. OASIS again had excellent calibration and discrimination (AUROC 0.776 vs 0.750 for APS III) whilst requiring a much smaller number of variables. OASIS has many applications, including both simplifying data collection for studies and improving the risk assessment therein.
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Redman, Pam. "Effectiveness of a Critical Care Nurse Residency Program." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3201.
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The importance of nurse residency programs is addressed in the literature; however, a review of residency program outcomes and effectiveness is needed. Guided by Roy's adaptation model and Deming's plan-do-check-act model, the purpose of this quality improvement project was to assess the current state of a longstanding critical care nurse residency program in meeting organizational goals and objectives and to recommend modifications to the program related to external factors, internal challenges, and educational deficits of nurses entering the program. A review of the evidence-based literature and feedback from focus groups of leadership stakeholders were used to develop recommendations for residency program improvement. Using qualitative analysis of the focus group data, three common themes emerged related to external factors: financial resources, patient acuity, and generational differences that influence nurse satisfaction with the residency program. Three additional themes emerged related to organizational barriers to satisfaction with the program: preceptor availability and development, limited training hours due to productivity standards, and leader time to support novice nurses. Reality shock when starting to practice in the high acuity critical care area was the most frequently reported educational deficit among new nurses. Recommendations for program improvement included obtaining feedback from residency program participants and preceptors, initiating preceptor development pathways, reinstituting a dedicated cost center for nurse residents' training, and using competency assessment tools to customize training plans for residency program participants. This project has the potential for social change by increasing job satisfaction and retention of new nurses and improving health outcomes in critical care patients.
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Corfee, Floraidh A. "Mental health and intensive care: A critical analysis." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/126393/1/Floraidh_Corfee_Thesis.pdf.
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This research addressed the social othering and positioning of mental health consumers in Australian society. Using a critical lens, the study explored the accounts of nurses caring for mental health consumers in intensive care. Interpretations of the accounts of interactions between nurses and consumers in this context brought focus to the ways in which nurses exercise legitimated power and privilege. It is hoped that the research will prompt critical reflection on the inherent structural power inequities in healthcare facilities and that political awareness of oppression and disenfranchisement of mental health consumers can be fostered among nurses as a professional group.
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Chalkley, Paul F. "‘Crying for home: Who really cares?’ A critical analysis of care giving in the context of Victorian residential care." Thesis, Australian Catholic University, 2018. https://acuresearchbank.acu.edu.au/download/f35e05d418bface1677d5bc4f0601cfc1788c863b6bb47202200b96e0dd408fb/951505/CHALKLEY_2018_Crying_for_home_who_really_cares.pdf.
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Residential care provides for approximately 500 children and young people in Victoria each year, yet the dynamics of providing care within this system have received little scholarly attention, at least in part because it forms a much smaller part of the system than home-based care – in 2014 there were 5,900 children and young people in foster care and kinship care in Victoria. It has long been recognised that, despite being highly traumatised and vulnerable, young people placed in the care of the state are often exposed to further distress, instability and torment because of the nature of the out-of-home care system, and the available literature confirms that this is certainly true in residential care. Central to the care these young people receive, and their experience of being ‘in care’, are the agents through which the care is delivered: residential care workers. This thesis fills a gap in knowledge by examining the perspectives and practice of residential care workers, asking how they understand their ability to support good outcomes for children and young people within the restrictions of residential care settings which are far from perfect.
This thesis presents the findings of a qualitative study of interviews with twelve residential care workers that was guided by the principles of grounded theory. Led by the themes which emerged from these interviews, this project examines the pillars of good practice as residential care workers themselves understand them – both those which they can directly articulate, and those which are part of their tacit knowledge.
The findings point to three key areas. Using the framework of ‘care’ as provided by Tronto, the three areas that emerged were (i) caring about, (ii) taking care of and (iii) care giving. At the heart of these areas are the concepts of being rooted in genuine relationships, trauma informed practice and connection to the community. These findings point to guiding principles that residential care workers see as helping them to be effective in not only doing their job, but also in providing authentic and personal care to the young people.
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Emmons, Margaret M. "Exploring the Enteral Feeding Practices Used by Critical Care Nurses: A Dissertation." eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsn_diss/34.
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Mechanically ventilated critically ill patients treated in the intensive care unit (ICU) require enteral feedings to maintain adequate nutrition during critical illness. Delivery of adequate enteral nutrition is also critical to the recovery of critically ill patients. Enteral nutrition has been shown to decrease length of time on the ventilator, decrease length of stay and ICU and decrease mortality. Despite all the evidence regarding the benefits of enteral nutrition, critically ill patients continue to receive less than their prescribed calories and protein. Nurses are in a unique position to influence the delivery of enteral nutrition. Nursing practices that contribute to underfeeding must be identified and corrected to ensure adequate delivery of nutrients is achieved. The purpose of the study was to describe the professional practice of critical care nurses regarding enteral feeding in mechanically ventilated critically ill patients. Several barriers were identified by the participants in the study that contributed to underfeeding including inconsistent practice regarding gastric residual volume, holding feeds when changing patient position and lack of a standardized protocol for enteral feeding. Also identified in the study was the idea that nurses do not see enteral feeding as a life-saving intervention. It is not the “sexy part” of what ICU nurses do. Enteral feeding guidelines need to be developed to include those interventions that are important to nursing practice in order to increase enteral feeding times and improve patient outcomes.
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Crawford, Theresa E. "Factors influencing critical care nurses' involvement with families in the intensive care unit." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0034/MQ66627.pdf.
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Lamoreaux, Nicole. "Critical Care Nurses' Perceptions of End-of-Life Care: Comparative 17-year Data." BYU ScholarsArchive, 2016. https://scholarsarchive.byu.edu/etd/6382.
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BACKGROUND: Nurses working in intensive care units (ICUs) frequently care for patients and their families at the end-of-life (EOL). Providing high quality EOL care is important for both patients and families, yet ICU nurses face many obstacles that hinder EOL care. Researchers have identified various ICU nurse-perceived obstacles, but no studies have been found addressing the progress that has been made over the last 17 years.OBJECTIVE: To determine the most common and current obstacles in EOL care as perceived by ICU nurses and then to evaluate whether or not meaningful changes have occurred since data were first gathered in 1998.METHODS: A quantitative-qualitative mixed methods design was used. A random, geographically dispersed sample of 2,000 members of the American Association of Critical-Care Nurses was surveyed.RESULTS: Five obstacle items increased in mean score and rank as compared to 1999 data including: (1) family not understanding what the phrase "life-saving measures" really means; (2) providing life-saving measures at families' requests despite patient's advance directive listing no such care; (3) family not accepting patient's poor prognosis; (4) family members fighting about use of life support; and, (5) not enough time to provide EOL care because the nurse is consumed with life-saving measures attempting to save the patient's life. Five obstacle items decreased in mean score and rank compared to 1999 data including (1) physicians differing in opinion about care of the patient; (2) family and friends who continually call the nurse rather than calling the designated family member; (3) physicians who are evasive and avoid families; (4) nurses having to deal with angry families; and, (5) nurses not knowing their patient's wishes regarding continuing with tests and treatments.CONCLUSIONS: Obstacles in EOL care, as perceived by critical care nurses, still exist. Family-related obstacles have increased over time and may not be easily overcome as each family, dealing with a dying family member in an ICU, likely has never experienced a similar situation. Based on the current top five obstacles, recommendations for possible areas of focus may include (1) improved nursing assessment regarding the health literacy of families followed with directed, appropriate, and specific EOL information, (2) improved care coordination between physicians and other health care providers to facilitate sharing care plans, (3) advanced directives that are followed as written by patients, (4) designated family contact communicating with family and friends regarding patient information, and, finally, (5) earlier, transparent discussions of patient prognoses as disease processes advance and patient conditions deteriorate.
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Rapley, Mark Timothy John. "Quality of life : a critical approach." Thesis, Lancaster University, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.337125.
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Kaddoura, Mahmoud. "New graduate nurses' perception of critical thinking development in critical care nursing training programs /." Access online resource, 2009. http://scholar.simmons.edu/bitstream/handle/10090/9655/Mahmoud%20Dissertation%207%20%20JULY.pdf?sequence=1.
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Singleton, Alsy R. "Patient satisfaction with nursing care : a comparison analysis of critical care and medical units." Virtual Press, 1997. http://liblink.bsu.edu/uhtbin/catkey/1061875.
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Patient satisfaction is an outcome of care that represents the patient's judgment on the quality of care. An important aspect of quality affecting patient's judgment can be attributed to patients' expectations and experiences regarding nursing care according to type of unit. The purpose of this study was to examine differences between patients' perceptions of satisfaction with nursing care in critical care units and medical units in one Midwestern hospital.The conceptual framework was "A Framework of Expectation" developed by Oberst in 1984, which asserted that patients have expectations of hospitals and health care professionals regarding satisfaction and dissatisfaction with care. The instrument used to measure patient satisfaction was Risser's Patient Satisfaction Scale, with three dimensions of patient satisfaction: (a) Technical-Professional, (b) Interpersonal-Educational, (c) Interpersonal-Trusting. The convenience sample included 99 patients50 from critical care units and 49 from medical wards. Participation was voluntary. The study design was comparative descriptive and data was analyzed using a t-test.The demographic data showed that the majority of patients had five or more admission. About one-third of the patients were 45-55, 56-65, 66-75, respectively. Findings related to the research questions were that: (a) 84 percent of the respondents rated overall satisfaction in the satisfactory to excellent range, (b) results of a t-test showed significant differences in overall patient satisfaction with patients being more satisfied with care in critical care units. Significant differences were found in three subscales with critical care being more satisfied. No relationship was found between patient satisfaction and age/and/or type of unit.Conclusions were that in both medical and critical care units patients were more satisfied with Technical-Professional and Interpersonal-Trusting than with Interpersonal-Educational. Also noted was that patients in the units where nurse-to-patient ratio was higher participants perceived that nurses had more time, energy and ability to meet patient expectation. Implications call for analysis of nurse/patient ratio in relation to patient satisfaction and nurses in relation to patient education as well as patient's perceptions of getting their needs met.School of Nursing