Tesis: "Critical care medicine"

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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 references
Background: 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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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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Jonge, Evert de. "Pathophysiology and management of coagulation disorders in critical care medicine". [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2000. http://dare.uva.nl/document/56631.

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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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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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Bandrauk, Natalie. "Futility and the proper goals of medicine : a critical care perspective". Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=78243.

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While the concept of medical futility has existed for as long as medicine has been practiced, it remains a controversial issue that has become more clouded as medicine has advanced. This thesis will explore futility in the most technologically rich and emotionally charged of settings, the intensive care unit. The complex interactions of biology, ethics and the law, with their competing and sometimes conflicting interests will be explored. Disputes between patients, families and health care workers over life-sustaining interventions occur most often in the ICU, and the factors that influence this dynamic, such as lack of communication, time constraints, media-driven misconceptions and value-conflicts, will be examined. Attempts to address futility through advance health directives and conflict resolution policies will be critiqued. But most importantly, this thesis will explain, by appealing to the proper goals of medicine, why limitations should be placed on end-of-life care, and why physicians have an important role to play in making these determinations.

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Reade, Michael Charles. "Characterisation and Novel Treatment of Several Causes of Mortality in Critical Illness". Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/15997.

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Three critical care syndromes form the main foci of this thesis: sepsis; delirium; and severe trauma. Research methods used to investigate the pathogenesis and novel treatments of these syndromes include clinical trials, observational studies, and preclinical models. In several instances, a complete research programme is presented. For example: • in the investigation of delirium, in which observational studies and empirical assessments of clinical measurement tools led to a pilot study and then the definitive 15-hospital clinical trial (Dexmedetomidine to Lessen ICU Agitation: DahLIA) comparing dexmedetomidine to placebo as a treatment for this condition; and • in the assessment of a haemodynamic protocol-guided treatment algorithm for septic shock, in which practice surveys and reviews of trial methodologies preceded three harmonised international clinical trials subsequently subjected to definitive meta-analysis. Other research programmes that are still in progress are also presented. For example: • the Cryopreserved vs. Liquid Platelets (CLIP) trial; • a programme that has developed a novel preclinical model of acute traumatic coagulopathy, in parallel with clinical trials of resuscitation in trauma such as the 1400-patient Pre-hospital Anti-fibrinolytics for Traumatic Coagulopathy and Haemorrhage (PATCH) trial; and • a research programme testing a protocolised approach to sedation, including the 4000-patient definitive Sedation Practice in Intensive Care Evaluation (SPICE) trial. A substantial part of this thesis includes collaborative applications of trial and observational methodologies to other critical care topics, including advanced-care planning, nutrition, oxygen delivery, lactate concentration, anaemia, coagulopathy, and the effects of gender and race. Research methodology is constantly evolving, and contributions to this process are outlined along with examples of research translation into practice through both policy and education.

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Conradie, Nathan John. "A comparison of critical care transportation modules taught in bachelor's degrees in emergency medical care in South Africa". Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32212.

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The aim of this literature review was to collect and appraise literature related to curricula in critical care transportation and retrieval, pre-hospital care, and aeromedical transportation. The search strategy was twofold. Firstly peer-reviewed published literature was sourced from established platforms. Secondly, grey literature was sourced from internet sources. An assessment of reliability and validity was performed on peer-reviewed literature in the appraisal process. The results of the literature review show that there is a paucity of literature describing critical care modules of pre-hospital educational programmes in South Africa. This lack of literature has led the authors of this review to conclude that there is a potential for insufficient benchmarking and standardisation of the critical care module between universities. The results of this study could allow stakeholders to begin the process of academic standardisation. To provide a comprehensive background on the field of critical care transportation and retrieval and specifically education and training, this literature review starts by describing the field locally. It then attempts to outline the risks associated with critical care retrieval and thereby demonstrating the importance of quality education and regulation that can guide practitioners who perform retrievals. It then seeks to understand the importance of standardsetting within education broadly and the role of curricula in standard-setting. Finally, it provides an overview of methods for comparing curricula. After the background sections, the gathered literature was grouped into themes according to the types of curricula included in the literature. All these types of curricula form part of the critical care transportation and retrieval field, as graduates from these programmes are usually involved in the transportation of critically ill patients between facilities.

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Bowers, Candice Andrea. "Barriers to implementation of evidence-based practices in a critical care unit". Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1013612.

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Over the last three decades there has been a greater need for health care practitioners to base their decision on the best available in order to optimise quality and cost-effective patient care. Evidence-based practice necessitates guideline development, education and review in order to achieve improved patient outcomes. However, initiatives that endeavour to disseminate and implement evidence-based practice have faced barriers and opposition. Barriers that might hamper the implementation of evidence-based practice include characteristics of the evidence itself, personal, institutional or organizational factors. The research study explored and described the barriers to implementation of evidence-based practices in a critical care unit. Based on the data analysis, recommendations were made to enhance the implementation of evidence-based practices in the critical care unit. A quantitative, explorative, descriptive and contextual research design was used to operationalize the research objectives. The target population comprised professional nurses in the critical care unit. Non-probability sampling was used to obtain data by means of a structured self-administered questionnaire. Descriptive data analysis was applied, using a statistical programme and the aid of a statistician. The results are graphically displayed using bar graphs and tables. Recommendations for nursing practice, education and research were made. Ethical principles have been maintained throughout the study.

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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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Ryder-Lewis, Michelle. "Reliability study of the sedation-agitation scale in an intensive care unit : a thesis submitted in partial fulfilment to the Victoria University of Wellington in fulfilment of the requirements for the degree of Master of Arts (Applied) Nursing /". ResearchArchive@Victoria e-Thesis, 2004. http://hdl.handle.net/10063/59.

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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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Gibbons, Patric. "Follow Your Heart: Evaluating Cardiac Function to Predict Outcomes Among ICU Patients with Traumatic Brain Injury". eScholarship@UMMS, 2018. https://escholarship.umassmed.edu/gsbs_diss/977.

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Introduction: Traumatic Brain Injury (TBI) remains a significant public health burden in the United States. Persons afflicted with more severe TBIs are usually admitted to an ICU, where they are at risk for a number of complications throughout their hospitalization. Recent literature has attempted to describe such complications from a cardiovascular perspective as part of a “cardio-cerebral syndrome.” We described the frequency of cardiac complications in the ICU among patients with a TBI and compared patients with and without measured cardiac dysfunction. We investigated the potential impact of cardiac dysfunction on in-hospital mortality. Methods: This was a retrospective review of a prospective cohort study in adult ICU patients with moderate-to-severe TBI (GCS≤12). We measured cardiac dysfunction using initial EKG echocardiography findings and peak serum troponin levels during hospitalization. Primary outcome was in-hospital mortality for patients with and without cardiac dysfunction using multivariable adjusted Cox Proportional Hazards Regression. Secondary outcomes examined the relationship between severity of brain injury and degree of cardiac dysfunction. Results: Ordinal logistic regression showed patients with more indicators of cardiac injury were significantly more likely to have greater brain injury as reflected by lower GCS scores (OR 0.76; 95%CI 0.58-0.99). There was a significantly increased multivariable adjusted risk of dying for each increase in measured cardiac injury (HR 2.41; 95% CI 1.29-4.53). Conclusions: Cardiac dysfunction was frequently observed in patients with TBI and we showed an association between increasing TBI severity and development of cardiac injury. Cardiovascular dysfunction was associated with an increased risk of in-hospital death. Adverse outcomes from TBI could potentially be mediated by cardiac injury, which could be used as a target for therapeutic intervention.

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McPeake, Joanne. "The health and social consequences of alcohol related admission to critical care". Thesis, University of Glasgow, 2015. http://theses.gla.ac.uk/6967/.

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Introduction: Alcohol related admissions to critical care are increasing. However, there is uncertainty about the impact of excessive alcohol use on the intensive care stay and recovery from critical illness. Aim: The aim of this study was to understand the impact of alcohol use disorders on the critically ill patient's journey. Settings & participants: The setting for this study was a 20 bed mixed ICU, in a large teaching hospital in Scotland. On admission patients were allocated to one of three alcohol groups: low risk; harmful/hazardous or alcohol dependency. Methods: This was a mixed methods study. An 18 month prospective observational cohort study was undertaken. In addition, 21 in depth, semi structured interviews were undertaken with patients with and without alcohol use disorders, three to seven months after discharge from critical care. Results: 580 ICU patients were screened for the presence of alcohol use disorders during the study period. 34.4% of patients were admitted with a background of alcohol misuse. ICU stay was significantly different between the three study groups, with those in the alcohol dependency group having a longer stay (p=0.01). After adjustment for all lifestyle factors which were significantly different between the groups, alcohol dependence was associated with more than a twofold increased odds of ICU mortality (OR 2.28; 95% CI 1.2-4.69, p=0.01). Four themes which impacted on recovery from ICU were identified in this patient group: psychological resilience; impact and support for activities of daily living; social support and cohesion; and the impact of alcohol use disorders on recovery. Conclusions: Alcohol related admissions account for a significant proportion of admissions to critical care and alcohol dependency is independently associated with ICU outcome. A more targeted rehabilitation pathway for all patients leaving critical care, with specific emphasis on alcohol misuse if appropriate, needs to be generated.

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Madelon, Myrlene. "Systematic Review of Sedation Management in the Pediatric Critical Care Unit". ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4743.

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Nurse-driven guidelines existed for the management of sedation in adult population; however, there is a lack of guidelines for the critically ill children. Nurses play significant roles in the management of sedation for mechanically ventilated patients in the Pediatric Intensive Care Unit (PICU), nonetheless, comprehensive guidelines for the management of sedation does not exist. The purpose of this systematic literature review was to evaluate and synthesize evidence-based research that can be used to adapt a pediatric clinical guideline for sedation management. The ACE star model and the evidence-based practice model were used as a framework to guide this review. The practice question focused on investigating the available best practices that can be used to support the nursing management practice of sedated patients in the PICU. This is important because inadequate sedation management can lead to multiple adverse outcomes for patients. The design of this project was a systematic literature review method. The sources of the data were gathered from Medline, PubMed, CINAHL, Joanna Briggs institute and Google Scholar. This review included 17 studies, of which 84.2% showed improvement with positive patient outcomes such as decreased sedation use, decreased length of stay, and improved nursing practice. The results also support recommendations for evidence-based practice guidelines in the clinical nursing practice setting. In conclusion, despite the recommendation for the use of sedation guidelines, this systematic review found that there are few studies comprehensively evaluating the impact of nurse-driven sedation management in the PICU. The social implication of this review is that more studies involving pediatric patients utilizing nurse-driven sedation protocol is needed, before it can be adopted in the PICU.

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BARTZ, CLAUDIA CAROL. "NURSE-PATIENT COMMUNICATION DURING CRITICAL ILLNESS EVENTS". Diss., The University of Arizona, 1986. http://hdl.handle.net/10150/183833.

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The purpose of this study was to explore and describe nurse-patient communication during critical illness events. The theoretical structure of the study was drawn from communication, sociolinguistic, and nursing theory. Data were collected in a 374-bed private hospital in the Southwest. The sample consisted of six registered nurses and nine patients experiencing cardiac surgery. Nine observed and audiotaped nurse-patient interactions, and fourteen audiotaped partcipant interviews provided the data base for analysis. Content analysis was used to organize the data. Findings were presented in terms of language, paralanguage, and nonverbal expression, and in terms of content, process, and product of nurse-patient communication. Participants used biomedical-technical language and casual-everyday language during the interactions. Nurses talked about what patients would experience while patients talked about themselves as a way of establishing their credibility within the biomedical setting. Nurses viewed nurse-patient communication as variable depending on the patients' needs and responses. Patients viewed nurse-patient communication as straightforward, not requiring adjustment for the needs of the participants. Products of communication for patients involved increased knowledge, reassurance, and increased confidence. Products of communication for nurses involved relieving the patients' anxieties, considering the patients' remembering, and increasing the nursing staff's knowledge about the patient while helping the patient to know the goals of the nursing staff. The introduction and closure segments of the six nurse-patient interactions for preoperative preparation of the patient were analyzed. Nurses began the introductions by assuming that the patients needed relief from anxiety but the patients demonstrated politeness more than anxiety. Nurses used strategies of questioning, starting the physical assessment, topic persistence, and self-monitoring to control the closure segments. Patients used narratives and humor as control strategies. The study findings suggest conceptual areas relevant to nurse-patient communication which may ground theoretical model development for nurse-patient communication. Nurses in clinical settings can compare their patient communication experiences with the findings of the study in order to increase their understanding of expression, form, and function of nurse-patient communication.

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Sintchenko, Vitali Public Health &amp Community Medicine Faculty of Medicine UNSW. "Decision by Design - Decision Support for Antibiotic Prescribing in Critical Care". Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2004. http://handle.unsw.edu.au/1959.4/21894.

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Decision support systems (DSS) are traditionally designed to optimise the outcomes of a decision. This thesis explores how DSS design can also be driven by the optimisation of the decision process leading to the decision, and how it may enhance the human uptake and use of DSS. It identifies which tasks could be simplified by decision support, and how to build DSS that are likely to be readily adopted and so improve decision outcomes. It tests the hypotheses that: (a) The analysis of specific process attributes of a given clinical decision task, as well as the information needs of its users, improves the design of DSS and enhances systems?impact and acceptance. (b) The complexity of the decision task is the key process attribute that, in conjunction with the information seeking of users, shapes the outcome of the design process. The work is applied to the domain of antibiotic prescribing in critical care. To explore the first hypothesis, the key attributes of prescribing decisions associated with specific prescribing subtasks and different decision-makers and decision contexts are identified and then analysed. Based on our findings, an information-processing model of decision support for an antibiotic-prescribing task is proposed. The second hypothesis is addressed by applying and comparing metrics for decision complexity including minimum message length, cognitive effort assessment and clinical algorithm structure analysis to the prescribing task. A framework is developed to select clinical decision tasks that may benefit from automation, by characterizing decision support as a process of complexity reduction for users, and these ideas are tested in the context of antibiotic prescribing for ventilator-associated pneumonia. The hypotheses are then tested by applying the task complexity framework to the design of a DSS for antibiotic prescribing in critical care. A web-based experiment and a clinical trial of the DSS are described, both of which study the acceptability and effectiveness of the system and verify the usefulness of the design framework. Specifically, in a before-after controlled trial, with no difference in patient mortality or severity of presentation between the two periods, the use of the DSS was associated with statistically significant improvements in patient outcomes and a reduction in antibiotic usage. The length of stay and total consumption of antibiotics decreased respectively from 7.15 to 6.22 days (P=0.02) and from 1767 to 1458 defined daily doses/1000 patient days (P=0.04). The introduction of a hand-held computer-based DSS was associated with less administration of ???broad-spectrum?antibiotics. The relative impact of the uptake of the DSS on the prescribing quality was quantified. Clinicians chose to use guidelines for one third, and pathology data or the DSS for about two thirds of cases for which they were available to assist their prescribing decisions. When used, the DSS plus pathology data improved the agreement of decisions with those of an expert panel - from 65% to 97% (P=0.002). The impact of the DSS was more significant on prescribing decisions of higher complexity. The level of decision complexity appeared to affect the choice of decision support type. Prescribing guidelines were accessed more often for lower complexity decisions, whereas the infection risk DSS plus pathology data were preferred for decisions of higher complexity. The need for measurement of the effectiveness of a DSS in improving decisions, as well as their likely rate of adoption in the clinical environment, was demonstrated. The thesis concludes with a proposal to apply the framework described to the modelling of the DSS adoption and to include task complexity and user information seeking as determinants of the design and evaluation of clinical DSS.

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Carnevale, Franco A. "Ethics and pediatric critical care : a conception of a 'thick' bioethics". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ37101.pdf.

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Martin, Kristy Ann. "The effect of earplugs on perceived sleep quality of acute care patients". Thesis, Montana State University, 2008. http://etd.lib.montana.edu/etd/2008/martin/MartinK0508.pdf.

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The purpose of this study was to evaluate the use of earplugs to improve perceived sleep quality in hospitalized patients. Sleep disruption is a common problem for hospitalized patients and has been shown to lead to physical and emotional complications. A variety of factors such as pain, illness, stress, worry, noise, lights and patient care activities contribute to disturbed sleep. Studies on sound in hospitals have shown that levels exceed recommendations by the Environmental Protection Agency. Limited research has shown that earplugs are a cost-effective, nonpharmacologic intervention with clinical usefulness to improve sleep quality. The study design was a quasi-experimental pilot study using a pre-test and post-test with the participants serving as their own control. Participants were recruited from a telemetry unit at St. Vincent Healthcare in Billings, Montana. The Verran and Snyder-Halpern Sleep Scales were selected to measure sleep quality. Ten participants were able to complete the two nights of study. The proposed hypothesis was supported for the sleep characteristic, soundness of sleep, with an improvement greater than 15 mm on the night with the ear plugs. Subjective findings identified positive comments with only one participant unable to tolerate the earplugs. The improvement in sleep was clinically significant for these participants. Hospitals should consider creating a sleep promotion policy and re-evaluating their night care practices. Earplugs could be included as an option for patients, and patients experiencing sleep difficulties should be encouraged to try earplugs. Further research is needed with a variety of populations and a large sample size. Research should also be done on nurses\' knowledge and beliefs regarding sleep and sleep interventions. This information could provide useful information on areas where additional education is needed.

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McLean, Christopher Duncan. "Thinking about patients and talking about persons in critical care nursing". Thesis, University of Southampton, 2012. https://eprints.soton.ac.uk/349086/.

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Nursing scholarship and healthcare policy set an expectation that nurses should think about patients as persons. Nevertheless, the literature reveals that critical care nurses can struggle to perceive patients as persons, and thus suggests they may think about patients in different ways. This thesis presents the findings of an ethnographic study undertaken within one critical care unit in the United Kingdom which examined how critical care nurses do think about patients. A purposive sampling strategy recruited 7 participants representing both experienced and inexperienced critical care nurses. Data were collected over a period of 8 months during 2006 to 2007, and primarily comprised the field notes from 92 hours of participant observation supplemented by 13 tape recorded interviews. Data analysis was influenced by Foucault and Goffman and adopted the perspective of linguistic ethnography. Analysis revealed that all participants thought about patients in seven distinct ways: as ‘social beings’, as ‘valued individuals’, as ‘routine work’, as a ‘set of needs’, as a ‘body’, as ‘(un)stable’ or as a ‘medical case’. Accounts of participants’ practice revealed that they had a tacit understanding that these different ways of thinking related to aspects of one coherent whole, but no one way of thinking could be characterised as thinking about this ‘whole person’. Nurses could only think about one aspect of the patient at a time. Nurses’ practice was not guided or explained by their thinking about patients as persons, but rather expert practice was characterised by nurses’ fluid and appropriate movement between different ways of thinking about patients. When participants talked about their practice it was evident that these nurses could only legitimately talk about themselves as giving care to persons. Participants characterised some of the ways in which they had to think about patients as impersonal, and this actively hindered these nurses from describing or reflecting upon elements of their practice. There is therefore conflict and dissonance between nurses’ expectation that they should think about patients as persons, and the fact that delivering nursing care requires them to think about patients in different ways. The development of future critical care nurses will require practitioners and educators to recognise that nurses think about patients in different ways, and that expert practice is characterised by the clinical wisdom which enables nurses to think about patients in ways which are appropriate to the moment. Nurse scholars and educationalists should therefore avoid claims to a unique professional knowledge base which suggest to nurses that some ways of thinking are always inappropriate or inherently reductionist. Instead, there is a need for scholars and policy makers to articulate a vision of person centred care clearly, and in ways which avoid constructing dissonance between nurses’ ideals, and the ways in which they do and must think about patients.

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Kalogeropoulos, Dimitris. "An intelligent clinical information management support system for the critical care medical environment". Thesis, City University London, 1999. http://openaccess.city.ac.uk/7714/.

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Significant advances have been achieved in the fields of medical informatics and artificial intelligence in medicine in the past three decades and, having demonstrated an ability to support clinical decisions, knowledge-based systems are becoming increasingly ubiquitous in various clinical settings. Nonetheless, few systems have so far been successful in entering routine use. On the one hand, primarily due to methodological difficulties and with very few exceptions, developers have failed to show that pertinent systems are effective in improving patient care. On the other hand, support systems have not been sufficiently well integrated into the routine information processing activity of the clinical users. As a consequence, their clinical utility is disputed and constructive assessmenist further hindered. This thesis describes the development of an intelligent clinical information management support system designed to overcome these obstacles through the adoption of an integrated approach, geared toward the solution of the problems encountered in the acquisition, organisation, review and interpretation of the clinical decision supporting information utilised in the process of monitoring intensive care unit patients with acid-base balance disorders. The system was developed to support this activity incrementally, using the methods of object-oriented analysis, design and implementation, with the active participation of a clinical advisor who assessed the functional and ergonomic compatibility of the system with the supported activity and the integration of a previously validated prototype knowledge-based data interpretation system, which could not evaluated in the clinical setting for the reasons described above.

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Henderson, Alan. "Some ethical problems in adult intensive care : a physician's approach to ethical problems at the bedside /". [St. Lucia, Qld. : s.n.], 2002. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16635.pdf.

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23

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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24

Fataar, Danielle. "Endotracheal tube verification in the mechanically ventilated patient in a critical care unit". Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1008057.

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Critically ill patients often require assistance by means of intubation and mechanical ventilation to support their spontaneous breathing if they are unable to maintain it. Mechanical ventilation is one of the most commonly used treatment modalities in the care of the critically ill patient and up to 90% of patients world-wide require mechanical ventilation during some or most parts of their stay in critical care units Management of a patient’s airway is a critical part of patient care both in and out of hospital. Although there are many methods used in verifying the correct placement of the endotracheal tube, the need and ability to verify placement of an endotracheal tube correctly is of utmost importance, because many complications can occur should the tube be incorrectly placed. Since unrecognized oesophageal intubation can have many disastrous effects on patients, various methods for verifying correct endotracheal tube placement have been developed and considered. Some of these methods include direct visualization, end-tidal carbon dioxide measurement and oesophageal detector devices. This research study aimed to explore and describe the existing literature on the verification of endotracheal tubes in the mechanically ventilated patient in the critical- care unit. A systematic review was done in order to operationalize the primary objective. Furthermore, based on the literature collected from the systematic review, recommendations for the verification of the endotracheal tube in the mechanically ventilated patient in the critical care unit were made. Ethical considerations were maintained throughout the study and the quality of the systematic review was ensured by performing a critical appraisal of the evidence found.

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25

Alabdali, Abdullah. "Interfacility critical care transfers in Saudi Arabia : measuring adverse events, mortality comparison and consensus on interventions in adult critical patients transferred by paramedics". Thesis, University of Warwick, 2017. http://wrap.warwick.ac.uk/98788/.

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Introduction: paramedics conducting interfacility transfer of critically-ill patients is one of the existing models in interfacility transfer. The paramedic model is available in multiple countries, including the Kingdom of Saudi Arabia. Paramedics’ expanded scope of practice has allowed them to transport, monitor and intervene with complex patients. This PhD thesis is designed to evaluate the safety of the paramedic model in Saudi Arabia conducting interfacility transportation of critically-ill patients. Method: the PhD thesis is mixed methods. A systematic literature review was conducted to examine literature on the safety of paramedics in interfacility transfers. A retrospective chart review was conducted to examine the incidence, predictors and pattern of adverse events seen in interfacility transfers by paramedics in Saudi Arabia. Following this, a retrospective chart review of interfacility transfers by physicians to the same institution was conducted to compare in-hospital mortality and 30-days survival in both groups. Finally, an expert survey was conducted to examine the consensus of paramedics’ intervention to adverse events seen in interfacility critical care transfers. Results: the literature showed that the frequency of adverse events seen by paramedics in interfacility transfers ranges from 5.1% to 18%. The rate of adverse events in adult critical patients transferred by paramedics to a tertiary care facility in Saudi Arabia was 13.7%, in-hospital mortality was 30.4% and 30-days survival was 68.1%. There is no significant difference regarding in-hospital mortality or 30-days survival between the paramedic and physician models. The paramedics’ interventions in interfacility adult critically-ill patients were rated appropriate by the majority of the experts in 86.8% of cases; the probability of an intervention to be appropriate was 84.9%. Conclusion: paramedics with appropriate training and skill can safely transfer critical interfacility adult patients. The mortality outcomes in the paramedic model are comparable to the physician model.

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Hall, Dana L. "Shifting the paradigm of trauma medicine to positively influence critical mortality rates following a mass casualty event". Thesis, Monterey, Calif. : Naval Postgraduate School, 2009. http://edocs.nps.edu/npspubs/scholarly/theses/2009/Jun/09Jun%5FHall%5FDana.pdf.

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Thesis (M.A. in Security Studies (Homeland Security and Defense))--Naval Postgraduate School, June 2009.
Thesis Advisor(s): Richter, Anke. "June 2009." Description based on title screen as viewed on July 13, 2009. Author(s) subject terms: Critical mortality, triage accuracy, definitive care, damage control, regional preparedness, standard of care, mass casualty event, trauma medicine, rationing, Spain, Israel, United Kingdom, Tactical Combat Casualty Care, TCCC. Includes bibliographical references (p. 73-78). Also available in print.

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27

Hammond, Janet Margaret Justine. "Nosocomial infections in intensive care". Master's thesis, University of Cape Town, 1993. http://hdl.handle.net/11427/26477.

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The objectives of this thesis are : 1) To provide a review of the literature on the significance, pathogenesis, diagnosis and management of secondary infections in the Intensive Care Unit. 2) To present the findings of a study of the technique of selective parenteral and enteral antisepsis regimen (SPEAR) in the patient population of the Respiratory ICU at Groote Schuur Hospital, aimed at reducing the incidence of secondary infection and, further to evaluate the study in terms of the effect of SPEAR on the incidence of secondary infection and its influence on the mortality due to secondary infection. 3) To present the findings of the effect of SPEAR on patient bacterial colonisation in the ICU, and to evaluate its longterm influence on the microbial flora of the ICU.

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28

Richardson, Annette. "Improving quality : assessment of risk, interventions and measuring improvement in critical care". Thesis, Northumbria University, 2018. http://nrl.northumbria.ac.uk/36239/.

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Introduction: My ten published papers focus on two domains of the quality agenda, patient safety and patient experience, concentrating on how quality improvement can reduce the occurrence of serious consequences of patient harm and poor patient experience. Aims: My goal was to design, test and discover how to make improvements in clinical practice in four areas: sleep deprivation, infection prevention, falls prevention and pressure ulcer prevention. Literature Review: There was limited evidence of successful strategies for change to improve quality. Common quality improvement challenges were within the complex critical care environment and an urgency to act without the focus on well-designed methods. Design and Methodology: A broad range of research methods was applied to evaluate the implementation of improvement interventions in critical care. These included: observational designs to uncover understanding on patient experience, activities and processes; before and after design; stepped cluster design and longitudinal time series design, utilised to increase confidence with attributable effect from the interventions. Results: My appraisal of my ten publications showed quality varied. Process and outcome measures were used to determine the success, and I received national and local recognition for some of my work. Discussion My three main knowledge contributions were: · practical ways to help nurses assess and improve patients’ sleep · risk assessment approaches · translation and implementation of improvement methodology in critical care. I discovered four cross-cutting themes which add to quality improvement knowledge and I developed an enhanced model for improvement. The four themes are: · clinical leadership at a programme and local level · using a bundle of technical and non-technical interventions · undertaking patient risk assessment to guide interventions · the value of data measurement and feedback Conclusions & Recommendations: My work has improved patient experience and patient safety knowledge. With further testing this knowledge could greatly benefit other areas of healthcare.

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Kruger, Jeanne-Marié. "Efficacy and safety of acidified enteral formulae in tube fed patients in an intensive care unit /". Link to online version, 2006. http://hdl.handle.net/10019/564.

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Pattison, Natalie A. "Cancer patients' care at the end of life in a critical care environment : perspectives of families, patients and practitioners". Thesis, Northumbria University, 2011. http://nrl.northumbria.ac.uk/1009/.

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Innovations in cancer care requiring intensive support, and improved cancer patient survival in and out of critical care, have led to greater numbers of cancer patients than ever accessing critical care. Of these, however, a fair proportion will die. Current research points to around one in six patients dying in general critical care units and even higher numbers for cancer patients. End-of-life care (EOLC) for critically ill patients is problematic and rarely addressed beyond satisfaction or chart review studies, while palliative care is an established domain in cancer. It is not known whether dying, critically ill cancer patients experience good EOLC. In the context of a cancer critical care unit, this thesis explores the provision of EOLC for cancer patients in a critical care unit. Exploring measures for comfort care and palliative principles of care helped identify what is important for patients and families, and what those measures meant for all participants. The diagnosis of cancer and how it impacts on EOLC provision for critically ill cancer patients was also explored from the perspective of patients, families, doctors and nurses. A Heideggerian phenomenological interview approach was undertaken, in order to gain personal experiences. Families of those patients who died after decisions to forgo life-sustaining treatment (DFLSTs) were interviewed. Patients who have experienced critical care were also interviewed, since patients‘ views about EOL care provision are very rarely explored. Doctors and nurses also contribute their vision for, and experiences of, EOL care in a cancer critical care unit. Thirty one interviews with 37 participants were carried out. Cancer prognosis together with critical illness prognosis contributed to difficulties in deciding to move to, and enact EOLC. The nursing voice in DFLSTs was minimal and their role in EOLC depended on experience and confidence. Achieving a good death was possible through caring activities that made best use of technology to prevent prolonged dying. EOLC was an emotive experience. Decision-making and EOLC could be difficult to separate out which, in turn, affects prospects for EOLC. A continuum of dying in cancer critical illness is presented with different participants‘ experiences along that continuum. Three main themes included: Dual Prognostication; The Meaning of Decision-Making; and Care Practices at EOL: Choreographing a Good Death with two organising themes: Thinking the Unthinkable and Involvement in Care. These themes outlined the essence of moving along a continuum toward patients‘ deaths and the impact that had on opportunities for care and a good death. Nurses could use the care of patients dying in critical care as an opportunity to develop specialist knowledge and lead in care, but this requires mastery and reconciliation of both technology and EOLC. This work builds on Seymour‘s (2001) theory of a negotiated and natural death related to achieving a good death in critical care. Trajectories of dying, part of Seymour‘s (2001) theory, are extrapolated on with reference to Glaser and Strauss (1965) and Lofland (1978)‘s theories on dying trajectories. Nursing theory is developed through examination of Falk Rafael‘s (1996) and Locsin‘s (1998) theories of empowered caring. Implications and propositions are presented for nursing and wider practice around EOL care for critically ill cancer patients.

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Diamond, Cara. "Patient experience of admission to critical care unit (CCU) during Haematopoietic Stem Cell Transplant (HSCT)". Thesis, University of Glasgow, 2013. http://theses.gla.ac.uk/4615/.

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Background: Critical care is the term used to encompass ‘intensive care units’, ‘intensive treatment units’ and ‘high dependency units’. These units provide expert care for critically ill patients who require constant, close monitoring and specialist nursing to keep them alive. Previous research has shown that admission to critical care can be a frightening, upsetting and traumatic experience. Haematological cancer patients who receive a haematopoietic stem cell transplant (HSCT) frequently require admission to critical care as a result of this potentially curative but extremely aggressive treatment. No previous research has explored the unique experience of HSCT patients admitted to critical care. Aim: To gain an in-depth understanding of the experience of cancer patients’ admission to critical care. Methods: Five HSCT patients who had been admitted to critical care completed semi-structured interviews. Transcripts were analysed using Interpretative Phenomenological Analysis. Results: Six superordinate themes were identified: gaps in recollection, unreal experiences, being in the right place, unexpected and unprepared, role of family and life after critical care. It was clear that despite the patients recalling potentially distressing experiences from their stay in critical care, they had no regrets about having the transplant and viewed their admission as being worth it. Themes are discussed in relation to relevant literature. Conclusions: This study offered a unique insight into the experience of being admitted to critical care following stem cell transplant. Implications for the treatment and care of cancer patients admitted to critical care are discussed.

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32

Liebenberg, Nuraan. "A critical analysis of pre-hospital clinical mentorship to enable learning in emergency medical care". Thesis, Cape Peninsula University of Technology, 2018. http://hdl.handle.net/20.500.11838/2737.

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Thesis (Master of Emergency Medical Care)--Cape Peninsula University of Technology, 2018.
For emergency medical care (EMC), clinical mentorship can be thought of as the relationship between the EMC students and qualified emergency care personnel. Through this relationship, students may be guided, supported and provided with information to develop knowledge, skills, and professional attributes needed for delivering quality clinical emergency care. However, this relationship is poorly understood and the focus of this research was to explore how this relationship enabled or constrained learning. Through having experienced mentorship, first as a student in EMC, then as an operational paramedic, mentoring students, I was privy to an insider perspective of clinical mentorship, and the experiences of fellow students‘. Through this experience the practices I observed may not have promoted learning. This is when my interest in pre-hospital clinical mentorship in relation to learning began. The aim of this research was to present a qualitative analysis of the clinical mentorship relationship in pre-hospital EMC involving the qualified pre-hospital emergency care practitioner (ECP) and the EMC student. The objectives included gaining an understanding of what enabled and/or constrained learning EMC, exploring clinical mentorship and learning in the pre-hospital EMC context, and gaining understanding of the role and scope of community members in the clinical mentorship activity system. The purpose of this study was to qualitatively document, by means of a thematic analysis, the pre-hospital clinical mentorship relationship, as well as document, by means of a Cultural Historical Activity Theory (CHAT) analysis, the clinical mentorship activity system. The focus of this qualitative documentation was the enablements and constraints to learning during clinical mentorship. This research also made possible recommendations for EMC clinical mentorship and education and may also inform (PBEC) policy, as well as work integrated learning (WIL) policy. Data collection included the use of diaries and focus group interviews. Analysis involved a two-part analysis, where data was reduced and understood with thematic analysis guided by Braun and Clarke (2006) six phase thematic analysis process (explained in Chapter three, Section 3.6). Thereafter, a CHAT analysis was conducted to uncover contradictions within the clinical mentorship activity system that made working on the object of activity difficult, thereby also uncovering constraints to learning. Inductive reasoning was applied to the thematic analysis to reduce data and identify themes and subthemes which provided insight into the enablements and constraints to learning in the pre-hospital EMC clinical mentorship relationship. The CHAT analysis of the data collected and analysed brought to surface the affordances, tensions as well as the primary-level and secondary-level contradictions of the clinical mentorship activity system. The thematic analysis of the clinical mentorship relationship provided limited understanding of the enablements and constraints to learning, and thus further motivated deeper analysis with CHAT. The results of this research included primary and secondary-level contradictions for almost all elements of the clinical mentorship activity system. Contradictions amongst the Division of Labour (DoL), the rules of the activity system, and the tools/resources of the activity system existed in that it constrained the interaction and activity of the subject and the community while working on the object of the activity system possibly achieving a lesser or undesired outcome of clinical mentorship.

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Boden, Christopher. "Older people and 'person-centred' podiatry : a critical evaluation of two models of care". Thesis, University of Gloucestershire, 2007. http://eprints.glos.ac.uk/1989/.

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Older people are often portrayed as a disadvantaged and silent group in society, whose views have been largely ignored. Demographic studies suggest the number of people over 75 years of age, as a percentageo f the population in coming years is likely to substantially increase, which will place greater demands on healthcare services. In the last two decades, health policy has focused on delivering high quality services based on individuals' needs, with a greater emphasis placed on individuals being involved in decisions about their care. This policy direction has facilitated a change in power relationships between patients and professionals and will require providers of healthcare to focus on delivering 'patient-centred' care at times and places that meet individual's needs and expectations. The aim of this researchw as to evaluatet he current medical model provision of NHS podiatry with the biopsychosocial model which claims to provide 'holistic', patient-centredc are. An important aim of this research was to provide a greater and more informed understandingo f what older people communicate about their 'lived' experiences, the significance of those experiences on care-seeking and their expectations of appropriate podiatry care. The research was undertaken with older people living in east Gloucestershire, who were 75 years old or over, and had requested NHS podiatry. The study was underpinned by a qualitative methodology, strengthened by a desire to change current clinical practice and inform health policy. The research methodology included involvement of participants in an innovative reminiscence technique, and as a consequence the 'podiatry patient career' was constructed. The texts generated from the participants were examined using an interpretative phenomenological analysis to ensure a 'person-centred' focus because it was imperative to hear the voices of the 'Participants' and not just the medical model 'patients' narrative. A portrait was revealed of older people who were conscious of their position in the life course and their own mortality, together with the effect this had on how they conducted their lives. The participants' raised consciousness of their 'self' affected their expectations, feelings, and interaction with others. For many of the participants there appeared a vicious circle of impending frailty that led to a diminishing circle of contacts which had an effect on their wider social activities and relationships. At this stage, participants perceived a resolution of their foot-care needs to be of great value and importance in maintaining their well-being which, assisted by the podiatrist, resulted in a handing over of the responsibility for their care. The conclusion is that neither model delivers 'person-centred' care to meet participants' expectations and foot-care needs. A new model is presented where differing and changing priorities, at different times of the participant's lived world will be relevant to meet their expectations and needs. The research concluded that the requirement for podiatry care can be taken as an early indicator of failing independence. The importance of the participant podiatrist relationship was also identified as cental to the delivery of 'person-centred' podiatry. The research findings depict older people who want to be involved in their care rather thm being 'a burden to the state. Recognition is also given to the changing nature of caring relationships in the next decade, and how NHS podiatry services will have to profoundly transform if they are to deliver a holistic, person-centred service in the future.

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Prins, Aletta Jacoba. "The expected role of the critical care clinical nurse specialist in private hospitals". Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/4313.

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Thesis (MCur (Nursing Science))--University of Stellenbosch, 2010.
Thesis presented in partial fulfilment of the requirements for the degree of Master of Nursing at Stellenbosch University
ENGLISH ABSTRACT: The trend towards specialisation in nursing has resulted in the development of the role of the Clinical Nurse Specialist (CNS) since the 1960s and 1970s in North America and the United Kingdom respectively. A Clinical Nurse Specialist should demonstrate excellent skills in leadership, communication, critical thinking, clinical and collaborative ethical decision-making, as well as mentoring. Research done internationally has shown that advanced practice nursing leads to higher patient satisfaction and compliance, fewer hospitalisations and shorter length of stays. The development of the CNS role in SA is slow in implementation. The South African Qualifications Authority has only recently published qualification rules for a master’s certificate and master’s degree in Nursing for advanced specialist nurses in SA. This situation led to the following research question: What is the expected role of the Critical Care Clinical Nurse Specialist in private hospitals in the northern and southern suburbs of the Cape Peninsula, South Africa? A non-experimental, explorative, descriptive study with a quantitative orientation was conducted in eight private hospitals in the Cape Peninsula. Through non-probability sampling 73 critical care health professionals (critical care professional nurses, clinical nurse specialists, nursing managers, unit managers, nurse educators, clinical facilitators, clinical coordinators and doctors) out of a population of 170 critical care health professionals participated in the study. A survey tool was designed and validated to collect the data. Quantitative data was analysed through Statistica® and qualitative data was analysed thematically. It was found that 81% of the participants agreed that Clinical Nurse Specialists should be appointed in the South African critical care environment as soon as possible to improve patient outcomes, to contribute to safer nursing care, to relieve work stress of shift leaders and bedside nurses and to improve the professional status of nursing. It is recommended that greater awareness regarding the Clinical Nurse Specialist should be developed. The relevant educational requirements should be finalised and a clear job description should be compiled. Nursing managers should appoint Clinical Nurse Specialists in each critical care unit as soon as possible.
AFRIKAANSE OPSOMMING: Die rol van die Kliniese Verpleegspesialis het as uitvloeisel van spesialisering in verpleging sedert 1960 en 1970 in Noord-Amerika en Groot-Brittanje onderskeidelik ontwikkel. `n Kliniese Verpleegspesialis behoort die volgende eienskappe te openbaar: uitmuntende vaardighede met betrekking tot leierskap, kommunikasie, kritiese denke, kliniese en etiese besluitneming en mentorskap. Internasionale navorsing het aangetoon dat gevorderde verpleegkunde tot `n hoër vlak van pasiënttevredenheid en nakoming van behandelingsvoorskrifte, minder hospitalisasie en korter hospitaalverblyf aanleiding gee. Die ontwikkeling van die rol van die Kliniese Verpleegspesialis in Suid- Afrika geskied langsaam. Die Suid-Afrikaanse Kwalifikasie-Outoriteit (SAKO) het eers onlangs die reëls vir `n meestersertifikaat en meestersgraad in Verpleegkunde vir gevorderde spesialisverpleegkundiges gepubliseer. Hierdie situasie het tot die onderstaande navorsingsvraag aanleiding gegee: Wat is die verwagte rol van die Kritiekesorg- Kliniese Verpleegspesialis in privaathospitale in die noordelike en suidelike voorstede van die Kaapse Skiereiland, Suid-Afrika? `n Nie-eksperimentele, beskrywende studie met `n kwantitatiewe benadering is in agt hospitale in die Kaapse Skiereiland onderneem. Deur nie-waarskynlikheids-, toevallige steekproefneming is 73 professionele betrokkenes by kritiekesorggesondheid (professionele kritiekesorgverpleegkundiges, kliniese verpleegspesialiste, verpleegbestuurders, eenheidsbestuurders, opvoeders in verpleegkunde, kliniese fasiliteerders, kliniese koördineerders en dokters) uit `n populasie van 170 professionele betrokkenes by kritiekesorggesondheid in die studie ingesluit. `n Vraelys is ontwerp en gevalideer vir die insameling van data. Kwantitatiewe data is deur middel van Statistica® ontleed terwyl die kwalitatiewe data tematies ontleed is. Daar is gevind dat die meerderheid van die deelnemers saamgestem het dat Kliniese Verpleegspesialiste so gou moontlik in die kritiekesorgomgewing in Suid-Afrika aangestel behoort te word. Die Kliniese Verpleegspesialis dra by om pasiëntuitkomste te verbeter, om tot veiliger verpleegsorg by te dra, om werkspanning van skofleiers en verpleegsters te help verlig en om die professionele status van verpleging te verbeter. Daar word aanbeveel dat daar groter bewusmaking aangaande die Kliniese Verpleegspesialis moet wees. Vereistes vir opleiding behoort gefinaliseer te word en `n duidelike werksbeskrywing moet opgestel word. Verpleegbestuurders behoort Kliniese Verpleegspesialiste so gou moontlik in die kritiekesorgomgewing aan te stel.

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Tolliver, Robert M., Jodi Polaha y S. Williams. "Rurality vs. SES as Critical Factors in the Prevalence of Child Psychosocial Concerns in Primary Care". Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/6590.

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Karlsson, Sofia y Annelie Lindberg. "Mobiliseringsmetoder vid en intensivvårdsavdelning- En litteraturstudie". Thesis, Karlstads universitet, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-41186.

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37

Rund, Joy E. J. "Investigation of diarrhoea in critically ill patients receiving enteral nutrition". Master's thesis, University of Cape Town, 1989. http://hdl.handle.net/11427/25541.

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The incidence and causes of diarrhoea among critically ill patients receiving enteral tube feeding were investigated. Sixty acutely ill surgical or medical intensive care patients who had had a minimum of 48 hrs bowel rest were entered into the study. They were randomly assigned to receive one of two lactose free liquid formula diets - "Ensure", a commercially available feed containing 825 kCal/L and 34 g/L of protein with an osmolality of 441mOsm/1 or "Casilan Oil", a home-made feed containing 840 kCal /L and 45g/L of protein with an osmolality of 383 mOsm/1. The feeds were administered by constant nasogastric infusion. Patients received 1000ml at a rate of 40ml per hour for the first day and up to 2000ml at 80 ml per hour for the remainder of the study period. Investigations included documentation of medical history, medications administered and clinical details for each patient. Serum albumin was measured and the nutritional status of each patient was assessed using anthropometric measurements. Feeds were tested for bacterial contamination on the three days following the start of feeding and small intestinal bacterial overgrowth was assessed by the 1 g-¹⁴C Xylose breath test of Toskes and King. Twelve of the sixty patients had to be withdrawn from the trial within 24 hours of the start of enteral feeding for medical reasons. The remaining forty eight patients completed at least three days on enteral feeding and thereby became eligible for analysis. In 10/48 patients (21%) diarrhoea was present before enteral feeding began. Four of these 1 O patients continued to pass loose stools when enteral feeding was started while the remaining 6 settled. Diarrhoea developed in a further 10 patients (21%) after enteral feeding began. The overall incidence of diarrhoea in the group of critically ill patients studied was therefore 42% (20/48). However, of the fourteen patients who experienced diarrhoea during enteral feeding four had diarrhoea before feeding began. Therefore, the true incidence of diarrhoea related to enteral feeding was only 10/38 (26%). Furthermore, in 7 of these 10 patients, another possible cause of diarrhoea was present. There was no significant association between diarrhoea and nutritional status, hypoalbuminaemia, sepsis, length of bowel rest, sucralfate and antibiotic therapy other than amikacin. Twenty one patients received Ensure and 27 received Casilan Oil. Despite the differences in the composition of the feeds, the incidence of diarrhoea was similar on the Ensure and the Casilan Oil. No particular factor pertaining to the composition of the feeds was associated with diarrhoea. Significant contamination of feeds was universal but there was no constant relationship between bacterial counts, or types, and the occurrence of diarrhoea. Certain other factors were found to be significantly associated with diarrhoea. Abdominal injury was positively associated with the occurrence of diarrhoea (p<0.05). Diarrhoea could have been attributed to the underlying disease state in 7 of the patients. All three patients who were receiving lactulose as treatment for liver failure developed diarrhoea. While no association was noted between diarrhoea and antibiotic therapy in general, treatment with the antibiotic, amikacin, correlated significantly, albeit marginally, with the occurrence of diarrhoea (p<0.05). Twenty six patients were tested for small intestinal bacterial overgrowth. Only one patient, with an elevated excretion of ¹⁴CO₂, indicative of small intestinal bacterial overgrowth, developed diarrhoea. There was, however, a positive association between diarrhoea and decreased excretion of ¹⁴CO₂. It would appear that the bacterial flora was suppressed in patients with diarrhoea. Amikacin therapy was also associated with decreased excretion of ¹⁴CO₂. This may suggest that amikacin could have altered the bowel flora with resultant development of diarrhoea. While abdominal injury and disease were associated with the development of diarrhoea and amikacin was a possible factor associated with diarrhoea, the results of the present study indicate that enteral tube feeding with either the commercial feed, Ensure or the home-made feed, Casilan Oil was not a cause of diarrhoea in the majority of critically ill patients assessed. Furthermore, in most patients who commenced the trial with diarrhoea, improvement was noted on enteral feeding.

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38

Sobuwa, Simpiwe. "A critical realist study into the emergence and absence of academic success among Bachelor of Emergency Medical Care students". Doctoral thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29475.

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This critical realist thesis explores academic success in the four-year Bachelor of Emergency Medical Care degree in South Africa. The Bachelor of Emergency Medical Care degree is a relatively new degree that is offered at four universities in South Africa. In view of the existing shortage of paramedics both in South Africa and on the African continent, an understanding of the factors that play a role in academic success may lead to an increase in the number of emergency care providers. Accordingly, this study was conceptualised to explore the reasons why academic success is either evident or absent among Bachelor of Emergency Medical Care students. The study utilised a sequential, explanatory, mixed methods research design. The quantitative phase consisted of an online survey that was disseminated to Bachelor of Emergency Medical Care students in South Africa with the aim of gaining an insight into their socio-cultural history. Continuous and categorical variables were described using basic descriptive statistics. The Pearson’s chi-square and Fisher’s exact test were used to test associations between the various survey variables and repeating a year. A p-value of less than 0.05 was considered to be statistically significant. During the qualitative phase focus groups were held with students while semi-structured interviews were conducted with lecturing staff members. The aim of the qualitative approach was to explore the causal powers and generative mechanisms that give rise to or enable the emergence or absence of academic success among Bachelor of Emergency Medical Care students. Thematic analysis was used to analyse results from the focus groups and semistructured interviews. A critical realist concept of the laminated system was also used to explore the themes that emerged. A total of 176 participants from an available sample of 408 students responded to the survey. Not repeating a year was significantly associated with two important variables, namely, the possession of a pre-existing emergency care qualification and not being a white student. The results revealed that the following interactive generative mechanisms played a role in the lack of academic success, namely, biological, socioeconomic, socio-cultural, normative, psychosocial and psychological factors while the following interactive generative mechanisms facilitated the emergence of academic success – psychological, psycho-social, normative and socioeconomic factors.

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39

Murray, Scott A. "A critical assessment of the use of rapid participatory appraisal to assess health needs in a small neighbourhood". Thesis, University of Aberdeen, 1995. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=128347.

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This study by an expanded primary health care team suggests that as a method of needs assessment rapid appraisal has a number of benefits and constraints. Major benefits include that it brings a community orientation to primary care; it is community participative; it is multi-sectoral and promotes networking; it promotes equity; as an action research method it facilitates change and that it can be satisfying to carry out. Major constraints include the possibility of researcher bias; that training is necessary for interviewing and understanding the method; that the results are not generalisable; that little health service data is produced; that only "proportionate accuracy" is obtained and that it can only be applied to a "community" in some sense of that word. The other methods highlighted shortcomings of using rapid appraisal as a sole means of health needs assessment. Each method yielded particular insights into both health and health care needs. A method mix is likely to give the most comprehensive picture. Rapid appraisal offers a practical way of involving local people in decision making about their health services and as an action research method facilitates change. As a training process it promotes the attitudes and skills which professionals need to work effectively in the community. Its value will depend on whether the data it generates is seen to be of use for purposes of resource allocation and community participation. At worst it has the potential to be a misused tool to collect poor information for supporting poor decisions. At best, it has the potential to give substance to the rhetoric of community participation by providing tools, techniques and data useful to planners and the public to be co-producers of health.

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Summers, Ronald. "A methodology for the design, implementation and evaluation of intelligent systems with an application to critical care medicine". Thesis, City University London, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.332618.

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41

Bell, Janet. "An investigation into the scope of practice of a registered critical care nurse in a private hospital". Thesis, Stellenbosch : University of Stellenbosch, 2011. http://hdl.handle.net/10019.1/16595.

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Thesis (MCur)--University of Stellenbosch, 2005.
ENGLISH ABSTRACT: The critical care nurse works in an environment where patient need often shifts the parameters within which she or he practices. It is expected of a skilled critical care nurse to be able to make independent decisions and take action regarding patient care based on her or his knowledge and skills without discounting the parameters of her or his scope of practice. Practice experience has indicated that the critical care nurse is often uncertain about whether her or his clinical activities are protected by the regulations provided by the Nursing Council. This is more specifically true in the private hospital industry where medical advice or assistance is not always easily available. This situation led to the following research question: Do the available professional and legal guidelines provide an appropriate foundation to guide the practice of the registered critical care nurse in the private hospital sector critical care environment? A non-experimental descriptive study with a qualitative orientation was conducted in 19 private hospitals in the Western Cape. Through nonprobability, random sampling, 71 registered critical care nurses were included in the study. A questionnaire was designed and validated to collect the data. Quantitative data was analysed through Excel® while qualitative data was analysed thematically. It was found that the legal and professional guidelines in place at present do provide a foundation for the clinical activities of critical care nursing in the private hospital sector. It is suggested that it is rather the critical care nurses’ interpretation of the Scope of Practice (No.R.2598 of 30/11/1984 as amended) that limits their practice as opposed to the wording of the regulations. It is recommended that critical care nurses must determine nursing care parameters based on patient need, using the regulations as a foundation for critical, analytical and reflective practice rather than as a set of rules to be followed. Key words: Scope of practice, critical care practice, ICU nursing care, private hospital nursing practice.
AFRIKAANSE OPSOMMING: Die kritiekesorgverpleegkundige werk in ‘n omgewing waar pasiëntebehoeftes gereeld die parameters waarin sy of hy praktiseer, verskuif. Dit word van ’n bekwame kritiekesorgverpleegkundige verwag dat sy of hy onafhanklike besluite en aksies met betrekking tot pasiëntesorg, gebaseer op haar of sy kennis en vaardighede, sal neem sonder om die parameters van haar of sy bestek van praktyk te oorskry. Praktykondervinding het getoon dat die kritiekesorgverpleegkundige dikwels onseker is oor watter van haar of sy optredes deur die Regulasies, soos deur die Raad op Verpleging gespesifiseer word, beskerm word. Dit is nog meer spesifiek van toepassing in die privaathospitaal-industrie waar geneeskundige advies en bystand nie altyd maklik beskikbaar is nie. Die situasie het tot die volgende navorsingsvraag aanleiding gegee: Voorsien die beskikbare professionele en wetlike riglyne ’n geskikte grondslag om die praktyk van ’n geregistreerde kritiekesorgverpleegkundige in die privaatsektor- kritiekesorgomgewing te rig? ’n Nie-eksperimentele, beskrywende studie met ’n kwalitatiewe oriëntasie is in 19 hospitale in die Wes-Kaap onderneem. Deur nie-waarskynlikheids-, toevallige steekproefneming is 71 geregistreerde kritiekesorgverpleegkundiges in die studie ingesluit. ’n Vraelys is ontwerp en gevalideer om inligting in te samel. Kwantitatiewe data is deur middel van Excel ontleed terwyl kwalitatiewe data tematies ontleed is. Daar is gevind dat die wetlike en professionele riglyne wat tans beskikbaar is, ‘n grondslag bied vir die kliniese aktiwiteite van kritiekesorgverpleegkundiges in die privaathospitaal.. Dit word voorgestel dat dit die kritiekesorgverpleegkundige se interpretasie van die Bestek van Praktyk (No.R.2598 of 30/11/1984 soos aangepas) is wat hulle praktyk beperk, eerder as die bewoording van die regulasie self.

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Farag, Mohamed S. "Development of Resilient Safety-Critical Systems in Healthcare Using Interdependency Analysis and Resilience Design Patterns". Thesis, The George Washington University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10981524.

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In the U.S. medical sector, software failures in safety-critical systems in healthcare have led to serious adverse health problems, including patient deaths and recalls of medical systems. Despite the efforts in developing techniques to build resilient systems, there is a lack of consensus regarding the definition of resilience metrics and a limited number of quantitative analysis approaches. In addition, there is insufficient guidance on evaluating resilience design patterns and the value they can bring to safety-critical systems.

This research employed the interdependency analysis framework to evaluate the static resilience of safety-critical systems used in the healthcare field and identified software subsystems that are vulnerable to failures. Resilience design patterns were first implemented to these subsystems to improve their ability to withstand failures. This implementation was followed by an evaluation to determine the overall impacts on system’s static resilience.

The methodology used a common medical system structure that collects common attributes from various medical devices and reflects major functionalities offered by multiple medical systems. Fault tree analysis and Bayesian analysis were used to evaluate the static resilience aspects of medical safety-critical systems, and two design patterns were evaluated within the praxis context: Monitoring and N-modular redundancy resilience patterns.

The results ultimately showed that resilience design patterns improve the static resilience of safety-critical systems significantly. While this research suggests the importance of resilience design patterns, this study was limited to explore the impact of structural resilience patterns on static resilience. Thus, to evaluate the overall resilience of the system, more research is needed to evaluate dynamic resilience in addition to studying the impact of different types of resilience design patterns.

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43

Flippies, Emirenthia Emogin Elouise y D. J. L. Venter. "The relationship between organisational contextual factors and clinical practice guideline implementation in private critical care units". Thesis, Nelson Mandela Metropolitan University, 2016. http://hdl.handle.net/10948/12583.

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Clinical practice guidelines are one way of ensuring that healthcare is based on the evidence-based practices. In a dynamic unit, like the critical care unit, where sound decision-making and critical thinking are required in the care of critically ill patients, the implementation of such guidelines for care is of utmost importance. Guideline implementation is however not so simplistic, and various studies have proven that there are various barriers linked to guideline implementation. However, most the barriers have proven to be related to individual factors. Therefore, a greater focus has been placed on organisational contextual factors that might have an influence on clinical practice guideline implementation. The research study followed a positivistic, quantitative paradigm, where the hypothesised relationship between the organisational contextual factors and clinical practice guideline implementation were investigated. A structured pre-existing questionnaire, namely the Alberta Context Tool, was used to collect data from 65 registered nurses in private critical care units. Descriptive and inferential statistics were used to analyse the data. The findings revealed that although the organisational contextual factors were prevalent in the private critical care units sampled, some factors like leadership and culture scored higher than the other factors. Positive relations were reported between the organisational contextual factors and clinical practice guideline implementation. The results imply that the alternative hypothesis H1 is supported, and thus proved that there are significant relationships between organisational contextual factors and clinical practice guideline implementation in private critical care units in the East London area.Recommendations were made on how to enhance organisational contextual factors in the implementation of clinical practice guidelines. Ethical principles were maintained throughout the study.

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44

Cretikos, Michelle School of Anaesthetics Intensive Care &amp Emergency Medicine UNSW. "An evaluation of activation and implementation of the medical emergency team system". Awarded by:University of New South Wales. School of Anaesthetics, Intensive Care and Emergency Medicine, 2006. http://handle.unsw.edu.au/1959.4/25720.

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Problem investigated: The activation and implementation of the Medical Emergency Team (MET) system. Procedures followed: The ability of the objective activation criteria to accurately identify patients at risk of three serious adverse events (cardiac arrest, unexpected death and unplanned intensive care admission) was assessed using a nested, matched case-control study. Sensitivity, specificity and Receiver Operating Characteristic curve (ROC) analyses were performed. The MET implementation process was studied using two convenience sample surveys of the nursing staff from the general wards of twelve intervention hospitals. These surveys measured the awareness and understanding of the MET system, level of attendance at MET education sessions, knowledge of the activation criteria, level of intention to call the MET and overall attitude to the MET system, and the hospital level of support for change, hospital capability and hospital culture. The association of these measures with the intention to call the MET and the level of MET utilisation was assessed using nonparametric correlation. Results obtained: The respiratory rate was missing in 20% of subjects. Using listwise deletion, the set of objective activation criteria investigated predicted an adverse event within 24 hours with a sensitivity of 55.4% (50.6-60.0%) and specificity of 93.7% (91.2-95.6%). An analysis approach that assumed the missing values would not have resulted in MET activation provided a sensitivity of 50.4% (45.7- 55.2%) and specificity of 93.3% (90.8-95.3%). Alternative models with modified cut-off values provided different results. The MET system was implemented with variable success during the MERIT study. Knowledge and understanding of the system, hospital readiness, and a positive attitude were all significantly positively associated with MET system utilisation, while defensive hospital cultures were negatively associated with the level of MET system utilisation. Major conclusions: The objective activation criteria studied have acceptable accuracy, but modification of the criteria may be considered. A satisfactory trade-off between the identification of patients at risk and workload requirements may be difficult to achieve. Measures of effectiveness of the implementation process may be associated with the level of MET system utilisation. Trials of the MET system should ensure good knowledge and understanding of the system, particularly amongst nursing staff.

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45

Tolliver, Robert M., Jodi Polaha y Stacey Williams. "Who Done It? Rurality vs. Ses as Critical Factors in the Prevalence of Child Psychosocial Concerns in Primary Care". Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/6595.

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46

Befile, Nomawethu. "The relationship between organisational culture, transformational leadership and organisational change outcomes in public intensive care units". Thesis, Nelson Mandela Metropolitan University, 2017. http://hdl.handle.net/10948/14576.

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Organisational change in any organisation, including the healthcare industry, implies a change in organisational culture. The concept of organisational culture refers to those values and norms within an organisation that are prescribed by both the employer and the employees as to how to behave. However, organisational culture should not be viewed in isolation, as culture and leadership are intertwined. Transformational leadership within an organisational culture serves to achieve its goal, missions and aims by influencing, motivating and creating a mutual relationship between employees and employers, which brings about effective organisational change. The alignment of organisational culture and leadership with a hospital’s vision is important to ensure optimal healthcare delivery and organisational change outcomes. A positivistic research paradigm, with a quantitative, explorative, descriptive and contextual approach, was used to conduct the research study. The research study explored whether a supportive organisational culture, transformational leadership and organisational change outcomes were prevalent in public intensive care units. Secondly, the study aimed to investigate the relationship between organisational culture, transformational leadership and organisational change outcomes in public intensive care units in the Nelson Mandela Bay. Data was collected by means of a structured and previously validated questionnaire with a Cronbach’s alpha of more than 0.80. The target population was registered nurses who work in the intensive care units in the public hospitals. The sample was composed of 56 registered nurses and 4 enrolled nurses who were selected from public hospital intensive care units in Nelson Mandela Bay. Descriptive statistics, linear regression analysis, correlation and a Chi-square test were used to describe the hypothesised relationship between organisational culture and transformational leadership (independent) with organisational change outcomes (dependent variable). The results of this study revealed that the alternative hypothesis was accepted as the P value, was less than 0.05 in all variables. This proved that there was a significant relationship between organisational culture, transformational leadership and organisational change outcomes in the public intensive care units which were sampled. Recommendations are made as to how organisational culture can enhance and support transformational leadership and organisational change outcomes to promote a positive change outcome in public intensive care units. Ethical considerations were maintained throughout the research study.

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47

Olatunji, Olatunde. "Education Program for Critical Care Nurses on Preventing Catheter-Associated Urinary Tract Infections". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7888.

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Catheter-associated urinary tract infections (CAUTIs) are the most frequently reported hospital-acquired condition, affecting more than 560,000 patients each year. CAUTIs prolong hospital stays and increase health care costs, and they can result in patient morbidity and mortality. Nurses can be empowered by receiving education and knowledge to manage and identify urinary catheters that are not clinically indicated. The purpose of this project was to develop an education program on CAUTI prevention for critical care nurses using the teach-back method. The conceptual framework that guided this project was Knowles's adult learning theory. The theoretical model was based on 4 fundamental assumptions of self-concept development. A total of 32 critical care unit nurses participated in the evaluation of the teach-back method. Demographic data were collected from these 32 participants, and the results of a frequency analysis were obtained. Deidentified CAUTI data were provided by the organization prior to the educational intervention. The postintervention CAUTI rate and increase in nurses' knowledge level were evaluated 1 month after the educational intervention using a 1-sample t test. The finding was statistically significant (p < .001). The incidence of CAUTI was followed, and the outcomes indicated that the overall incidence of CAUTI in these patients was decreased. The education program was effective in improving critical care unit nurses' knowledge of evidence-based practices to prevent CAUTIs. Improving nurses' knowledge to decrease CAUTI rates is a strategy that may be effective in many healthcare settings. This educational intervention may create social change by improving the health of patients and serving as an educational resource for nurses.

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48

Love, Janine Ann. "Respiratory management of the mechanically ventilated spinal cord injured patient in a critical care unit". Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1008451.

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Background: Spinal Cord Injuries (SCIs) are traumatic, life-changing injuries that can affect every aspect of an individual's life and can lead to death if not treated timeously and appropriately. Respiratory complications occur frequently after the SCI and are the leading cause of mortality and morbidity. Respiratory complications are predictable based on the neurological level of impairment of the spinal cord lesion; the higher the neurological injury, the more severe the respiratory complication. Changes in pulmonary function, poor cough, hypersecretion, immobility and bronchospasm all contribute to the development of respiratory complications. If the patient is unable to protect his/her airway or if respiratory failure occurs, mechanical ventilation is often required. Many patients require prolonged ventilation and subsequently need to go for tracheostomies. The critical care nurse plays an important role in the early identification of complications and can, therefore, act to limit and prevent these complications, which may be a direct result from the injury or treatment modality such as mechanical ventilation. Respiratory management has been promoted in preventing and treating respiratory complications and is associated with better prognosis in the SCI patient. Design and method: The research study aims to explore and describe existing literature and to make recommendations for the respiratory management of a mechanically ventilated spinal cord injured patient in a critical care unit (CCU). A systematic review was undertaken with clear inclusion and exclusion criteria. Ethical principles were maintained throughout the study. The quality of the study was ensured by critically appraising data that was utilized in the systematic review. It is envisaged that the results from this systematic review will improve the respiratory management of the SCI patient and prevent any variations in practice. Results: Were presented under the following themes: priorities of care for the SCI patient in the acute phase, during the critical care phase and preventative care. Conclusion: The SCI patient regardless of the neurological level or completeness of injury should be admitted to the CCU for intensive ventilatory, cardiopulmonary support and hemodynamic monitoring in order to detect and prevent respiratory complications. The use of larger tidal volumes is associated with improved comfort and less dyspnea however if a patient has acute lung injury or ARDS the use of low tidal volumes 6ml/kg is recommended. Prevention and early identification of respiratory complications is associated with improved outcomes for the SCI patient.

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49

Isa, Shawqi. "Leading and following : an exploration of the factors that facilitate or inhibit effective leadership in critical care settings in Bahrain". Thesis, University of Southampton, 2012. https://eprints.soton.ac.uk/344742/.

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The intention of this case study research is to explore the factors that facilitate or inhibit effective leadership in Critical Care Settings (CCSs) in a government hospital in Bahrain. The study focuses on Head Nurses (HNs) working in the CCSs, since those positions play a pivotal role in creating and maintaining a Healthy Working Environment (HWE) for nursing practice. In this research the abbreviation ‘Head Nurse (HN)’ will be used and it stands for Charge Nurse/ Ward Sister/ Nurse Supervisor. According to Ministry of Health (MoH) policies, the leadership in Bahrain encounters a variety of challenges including: demands for efficiency, cost cutting and a value for money service; finding alternative ways of funding; ensuring appropriate human resources; supporting improved management practices; developing a proper structure; higher customer expectations; and knowledge armed customers. A qualitative case study design was used. This approach allows the study to explore the important factors that facilitate or hinder leadership effectiveness such as the individual professional factors (e.g. leadership style, communication, the relationship, and the educational factors) and the organizational factors which include for example healthy working environment and the organizational structure. Data were gathered through in-depth semi-structured interviews with key informants (KIs), HNs and Senior Staff Nurses (SSN), as well as through observing HNs in clinical practice and document analysis (e.g. minutes of meetings and department annual reports). The emerging qualitative data have been analysed through coding and grouping according to themes. The findings revealed that effective HN leaders were recruited, and designated to the posts without development plans or without formal presentation. There was a lack of effective HN leaders who have the capabilities that are considered crucial in such a role (e.g. characteristics of emotional intelligence and authenticity). The study findings generated generic issues surrounding leadership in healthcare settings which resonate with the literature. The participants in this study talked about the characteristics of effective leaders in general rather than specifically emphasizing on issues like being in the frontline during a crisis to make quick decision that are required in critical situations. Key messages from the research indicate that effective head nurse leaders play a pivotal role in establishing and sustaining a healthy working environment. Also head nurses working in critical care settings should exhibit specific characteristics such as being: empathetic, open and honest, optimistic, visionary, accessible to be effective leaders.

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Jennings, Elizabeth M. "Matters of life and death : rationalizing medical decision-making in a managed care nation /". Diss., Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC IP addresses, 2002. http://wwwlib.umi.com/cr/ucsd/fullcit?p3049667.

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Tesis sobre el tema "Critical care medicine"

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