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1
Adomat, ReneeÌ. "Measuring nursing workload in intensive care". Thesis, University of Birmingham, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.397781.
Testo completo
2
Dunbar, Pervell Velethia. "Nursing Care of Terminal patients in Intensive Care Units". ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1379.
Testo completoAbstract (sommario):
Nursing Care for Terminal Patients in Intensive Care Units
by
Pervell Dunbar
Project Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Nursing Practice
Walden University
August 2015
Although the goal of the ICU has always been to save lives, ICU now additionally provides end-of life (EOL) care. The objective of this project was to provide ICU nurses with a comprehensive awareness of physical, emotional, and spiritual EOL care issues of patients and their families in order to be better equipped to handle EOL care. The framework used was Jean Watson's Caring model (10 Caritas). A literature review revealed a poster previously used by a major health organization as a conversation starter to facilitate decision-making among ICU nurses, EOL patients, and their families related to EOL issues. The purpose of this quality improvement initiative was to introduce and implement an educational EOL tool that would engage patients and family members in meaningful and useful conversations with ICU nurses. Twenty seven ICU nurses were selected by the unit's director to attend a PowerPoint presentation on the use of the EOL educational poster. Four ICU nurses were chosen by the director to be champions for this project. After the presentation, there was a period for questions and answers, and the ICU nurses were requested to give feedback on the presentation. The result from the feedback revealed that EOL care is outside previous practice and may require extra education and support. These comments substantiated similar conclusions from other researchers as described in this paper. With an increase in EOL training for ICU nurses and the implementation of EOL teaching tools like the poster used in this study, ICU nurses may be better able to have conversations with EOL patients and families, thus improving patient care.
3
Cronqvist, Agneta. "The moral enterprise in intensive care nursing". Doctoral thesis, Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-942-0/.
Testo completo
4
Moon, Mikyung. "Relationship of nursing diagnoses, nursing outcomes, and nursing interventions for patient care in intensive care units". Diss., University of Iowa, 2011. https://ir.uiowa.edu/etd/3356.
Testo completoAbstract (sommario):
The purpose of the study was to identify NANDA - I diagnoses, NOC outcomes, and NIC interventions used in nursing care plans for ICU patient care and determine the factors which influenced the change of the NOC outcome scores. This study was a retrospective and descriptive study using clinical data extracted from the electronic patient records of a large acute care hospital in the Midwest. Frequency analysis, one-way ANOVA analysis, and multinomial logistic regression analysis were used to analyze the data. A total of 578 ICU patient records between March 25, 2010 and May 31, 2010 were used for the analysis. Eighty - one NANDA - I diagnoses, 79 NOC outcomes, and 90 NIC interventions were identified in the nursing care plans. Acute Pain - Pain Level - Pain Management was the most frequently used NNN linkage. The examined differences in each ICU provide knowledge about care plan sets that may be useful. When the NIC interventions and NOC outcomes used in the actual ICU nursing care plans were compared with core interventions and outcomes for critical care nursing suggested by experts, the core lists could be expanded. Several factors contributing to the change in the five common NOC outcome scores were identified: the number of NANDA - I diagnoses, ICU length of stay, gender, and ICU type.
The results of this study provided valuable information for the knowledge development in ICU patient care. This study also demonstrated the usefulness of NANDA - I, NOC, and NIC used in nursing care plans of the EHR. The study shows that the use of these three terminologies encourages interoperability, and reuse of the data for quality improvement or effectiveness studies.
5
郭子琪 e Chi-ki Priscilla Kwok. "Nurse-controlled intensive insulin infusion in adult intensive care unit". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40720858.
Testo completo
6
Kwok, Chi-ki Priscilla. "Nurse-controlled intensive insulin infusion in adult intensive care unit". Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B40720858.
Testo completo
7
Davis, Clare. "Optimising nursing shift handover in Paediatric Intensive Care". Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/2943.
Testo completo
8
Ferreira, Josà Hernevides Pontes. "Team perception of nursing care humanized in intensive care unit neonatal". Universidade Federal do CearÃ, 2016. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=16481.
Testo completoAbstract (sommario):
CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel SuperiorHospitalization of the newborn is necessary when health conditions require immediate assistance for their recovery. Humanized actions in the neonatal unit have been developed in order to make it less painful separation parent-child when it needs technological support and team of trained professionals. It was aimed to analyze the perception and knowledge of the nursing team on the promotion of humanized care for newborn in a Neonatal Intensive Care Unit . It is a qualitative study conducted in a public hospital, large, tertiary level, in Fortaleza, Brazil, in the months October and November 2015, after approval by the Research Ethics Committee, under Protocol N. 1,191,339. The subjects were 14 nurses and 20 nursing technicians working in neonatal care. The data collected through semi-structured interviews consist identification data and five guiding issues that permeate the knowledge of the nursing team about the care and promotion of humanized care in the UTIN. In addition, we used no-participant observation and field diary. For analysis, we sought to Bardin technique that extracted the three categories lines: âTaking care of the human personâ, ânursing contributions to the humane careâ and âFactors that affect the quality of humanized care.â The results showed that the nursing team understands humanization as an indispensable element for the comprehensive care to the baby and family, which was observed from the speeches of welcome, restoring health and disease of the newborn process. The professionals had knowledge of the humanized care, played their actions conscious, oriented and appreciative way about the quality of neonatal care and parents who face the challenges inherent in the admission process. We conclude that the performance of these professionals permeates compliance with the regulations of the National Humanization Policy regarding humanized care to the newborn, family and neonatal ambience. It is believed that such actions minimize the impact caused by the characteristics of the disease treatment as well as stressors.
A hospitalizaÃÃo do recÃm-nascido faz-se necessÃria, quando as condiÃÃes de saÃde requerem assistÃncia imediata para o seu restabelecimento. As aÃÃes humanizadas na unidade neonatal tÃm sido desenvolvidas, a fim de tornar menos dolorosa à separaÃÃo pais-filho, quando este necessita de suporte tecnolÃgico e equipe de profissionais capacitados. Objetivou-se analisar a percepÃÃo e conhecimentos da equipe de enfermagem sobre a promoÃÃo do cuidado humanizado ao recÃm-nascido internado na Unidade de Terapia Intensiva Neonatal (UTIN). Trata-se de estudo qualitativo, realizado em hospital pÃblico, de grande porte, nÃvel terciÃrio, em Fortaleza-CE-Brasil, nos meses outubro e novembro de 2015, apÃs aprovaÃÃo pelo Comità de Ãtica em Pesquisa, sob Protocolo n 1.191.339. Os sujeitos foram 14 enfermeiros e 20 tÃcnicos de enfermagem atuantes na assistÃncia ao neonato. Os dados coletados, por meio de entrevista semiestruturada, consistem dados de identificaÃÃo e cinco questÃes norteadoras, que permeiam o conhecimento da equipe de enfermagem acerca do cuidado e a promoÃÃo da assistÃncia humanizada na UTIN. Ademais, utilizou-se observaÃÃo nÃo participante e diÃrio de campo. Para anÃlise, sÃntese e descriÃÃo, buscou-se a tÃcnica de Bardin, que se extraÃram das falas trÃs categorias: âCuidar do ser humanoâ, âContribuiÃÃes de enfermagem para o cuidado humanizadoâ e âFatores que interferem na qualidade do cuidado humanizadoâ. Os resultados revelaram que a equipe de enfermagem compreende a humanizaÃÃo como elemento indispensÃvel para o cuidado integral ao bebà e famÃlia, o que se observou desde as intervenÃÃes de acolhimento, ao restabelecimento do processo saÃde-doenÃa do neonato. Os profissionais apresentaram conhecimentos acerca do cuidado humanizado, desempenharam suas aÃÃes de forma consciente, orientada e sensibilizada, quanto à qualidade da assistÃncia ao neonato e aos pais que enfrentam os desafios inerentes ao processo de internaÃÃo. Percebe-se, portanto, que a atuaÃÃo desses profissionais permeia o cumprimento aos regulamentos da PolÃtica Nacional de HumanizaÃÃo. Conclui-se que o cuidado humanizado aplicado nessa ambiÃncia à essencial ao recÃm-nascido e famÃlia, uma vez que minimiza o impacto causado pelas caracterÃsticas da doenÃa, tratamento, bem como os fatores estressantes da UTIN.
9
Wolak, Eric S. "Perceptions of an intensive care unit mentorship program". Greensboro, N.C. : University of North Carolina at Greensboro, 2007. http://libres.uncg.edu/edocs/etd/1492Wolak/umi-uncg-1492.pdf.
Testo completoAbstract (sommario):
Thesis (M.S.N.)--University of North Carolina at Greensboro, 2007.Title from PDF t.p. (viewed Mar. 3, 2008). Directed by Susan Letvak; submitted to the School of Nursing. Includes bibliographical references (p. 53-58).
10
Goldsborough, Jennifer. "Palliative Care Integration in the Intensive Care Unit". ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4787.
Testo completoAbstract (sommario):
Palliative health care is offered to any patient experiencing a life limiting or life changing illness. The palliative approach includes goals of care, expert symptom management, and advance care planning in order to reduce patient suffering. Complex care can be provided by palliative care specialists while primary palliative care can be given by educated staff nurses. However, according to the literature, intensive care unit (ICU) nurses have demonstrated a lack of knowledge in the provision of primary care as well as experiencing moral distress from that lack of knowledge. In this doctor of nursing practice staff education project, the problem of ICU nurses' lack of knowledge was addressed. Framed within Rosswurm and Larrabee's model for evidence-based practice, the purpose of this project was to develop an evidence-based staff education plan. The outcomes included a literature review matrix, an educational curriculum plan, and a pretest and posttest of questions based on the evidence in the curriculum plan. A physician and a master's prepared social worker, both certified in palliative care, and a hospital nurse educator served as content experts. They evaluated the curriculum plan using a dichotomous 6-item format and concluded that the items met the intent of the objectives. They also conducted content validation on each of the pretest/posttest items using a Likert-type scale ranging from 1 (not relevant) to 4 (very relevant). The content validation index was 0.82 indicating that test items were relevant to the educational curriculum objectives. Primary palliative care by educated ICU nurses can result in positive social change by facilitating empowerment of patients and their families in personal goal-directed care and reduction of suffering.
11
Gill, Fenella. "Paediatric intensive care nursing behaviours to reduce parental stress". Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2001. https://ro.ecu.edu.au/theses/1028.
Testo completoAbstract (sommario):
A child's admission to a paediatric intensive care unit (PICU) is stressful for the family. Parental presence and involvement with their child in hospital have been recognised as important in reducing their stress. Several studies have identified parental needs in the PICU. Nurses have reported that they felt inadequately prepared to meet those needs. Although principles to guide nursing strategies have been identified, contextual behaviours of PICU nurses to reduce parental stress have not A qualitative study, using an ethnographic approach, was designed to describe contextual behaviours of experienced PICU nurses. Participants self identified their level of clinical practice to be at The Competency Standards for Specialist Critical Care Nurses (CACCN Inc., 1996). Fifteen nurses from six Australian PJCUs (two each in Brisbane and Sydney, one each in Melbourne and Adelaide) were interviewed. Recalled critical incidents identifying nursing behaviours to reduce parental stress were audiotaped, transcribed, analysed and interpreted. NUD•IST (version 4.0) was used to facilitate the initial data analysis. King's conceptual framework for nursing (1981), was used to illustrate the interactions of the interpersonal relationships between staff and parents and the effect of the culture within the PlCU. King's conceptual framework consists of three interacting, open systems; individuals as personal systems, two or more individuals forming interpersonal systems, and larger groups with common interests forming social systems or cultures. The nurses described parental stressors and behaviours. Nursing behaviours were anticipatory or in response to parental cues. Demonstrating empathy, sensitivity, caring and encouraging the parental role enabled rapport to be developed. Keeping parents fully informed, listening and talking through problems were also important stress reducing behaviours. PICU cultural behaviours, such as restricting parents' presence with their child, resulted in increased stress. The nurses found their role more difficult when parents were non English speaking, were of a different culture, religion or social background, or had long stays in the PICU. The nurses' personal challenges included the death of a patient, the need to remain impartial, and the pressure to always perform. The PICU nurses' ability to quickly establish rapport during a stressful time in the parents' lives was crucial to be able to reduce their stress. Many contextual nursing behaviours to reduce parental stress were described. However, consideration must be given to modifying those behaviours that increased parental stress. From both the perspective of positive and negative nursing behaviour, this study will enable nurses to be aware of behaviours that reduce and exacerbate parental stress in order to improve their practice in supporting parents.
12
Wallace, Amanda. "Effects of Telemedicine in the Intensive Care Unit on Quality of Care". ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1612.
Testo completoAbstract (sommario):
The growing concern over the nursing shortage has affected the intensive care unit (ICU) and how these units provide quality care, adhere to best practices, and maintain high satisfaction scores. Implementing telemedicine technology allows the ICU to have additional staff available, via cameras at an offsite location, to assist with patient care. The purpose of this project was to evaluate the potential benefits of telemedicine application used within an ICU on quality of care, adherence to best practices, and satisfaction, as evidenced by data from the hospital's telemedicine dashboard. The goals of this project were to reduce length of stay, increase staff satisfaction, and increase compliance with best practices. The diffusion of innovation theory was used to bring about successful change among team members in the ICU. The Focus Plan, Do, Study, Act methodology was used to determine what improvements were needed in the ICU. The evaluation of the telemedicine unit demonstrated early signs of positive progress. Actual length of stay (3.25 days) from the hospital's telemedicine dashboard was less than the predicted length of stay (3.8 days), and adherence to best practice was at or above target (95%) when compared to all telemedicine units across the nation, as provided by the telemedicine dashboard. Implementing a telemedicine unit will bring about a transparency and standardization of Intensive Care services, leading to positive social change in the organization. This social change, combined with the success of the unit, can influence other non-academic healthcare institutions to pursue telemedicine technology.
13
Njenje, Charles Chukwuemeka. "Improving Hand Hygiene in an Intensive Care Unit". ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5914.
Testo completoAbstract (sommario):
Health-care-associated infections (HCAIs) affect hundreds of millions of people worldwide, causing morbidity and mortality among hospitalized patients. About 2 million patients suffer from HCAIs in the United States, and it is estimated that 99,000 of them die each year. Studies have indicated that transmission of health-care-associated microorganisms occurs through contaminated hands of health care workers. Hand hygiene (HH) is the single most effective way to prevent health-care-associated infections, yet health care workers' hand hygiene compliance remains low. One factor responsible for poor compliance with hand hygiene guide-lines are lack of knowledge of good hand hygiene and lack of hand hygiene techniques. This project evaluated the effect of educational program on hand hygiene for intensive care unit (ICU) healthcare workers. The Health Belief Model was applied as the framework in this project. Key components of the model are perceived susceptibility, perceived severity, perceived benefit, and perceived barriers. A convenience sample of 25 ICU healthcare workers participated in the educational program. Pre- and post- education surveys and tests were assessed using descriptive statistics. Results were consistent with existing findings indicating that education is needed to improve HH compliance and that effective HH reduces infections. The findings from this project may contribute to positive social change by promoting increased HH knowledge and infection prevention while decreasing complications of treatments, costs, morbidity, and mortality, thereby promoting a healthy and safe community.
14
Singleton, Alsy R. "Patient satisfaction with nursing care : a comparison analysis of critical care and medical units". Virtual Press, 1997. http://liblink.bsu.edu/uhtbin/catkey/1061875.
Testo completoAbstract (sommario):
Patient satisfaction is an outcome of care that represents the patient's judgment on the quality of care. An important aspect of quality affecting patient's judgment can be attributed to patients' expectations and experiences regarding nursing care according to type of unit. The purpose of this study was to examine differences between patients' perceptions of satisfaction with nursing care in critical care units and medical units in one Midwestern hospital.The conceptual framework was "A Framework of Expectation" developed by Oberst in 1984, which asserted that patients have expectations of hospitals and health care professionals regarding satisfaction and dissatisfaction with care. The instrument used to measure patient satisfaction was Risser's Patient Satisfaction Scale, with three dimensions of patient satisfaction: (a) Technical-Professional, (b) Interpersonal-Educational, (c) Interpersonal-Trusting. The convenience sample included 99 patients50 from critical care units and 49 from medical wards. Participation was voluntary. The study design was comparative descriptive and data was analyzed using a t-test.The demographic data showed that the majority of patients had five or more admission. About one-third of the patients were 45-55, 56-65, 66-75, respectively. Findings related to the research questions were that: (a) 84 percent of the respondents rated overall satisfaction in the satisfactory to excellent range, (b) results of a t-test showed significant differences in overall patient satisfaction with patients being more satisfied with care in critical care units. Significant differences were found in three subscales with critical care being more satisfied. No relationship was found between patient satisfaction and age/and/or type of unit.Conclusions were that in both medical and critical care units patients were more satisfied with Technical-Professional and Interpersonal-Trusting than with Interpersonal-Educational. Also noted was that patients in the units where nurse-to-patient ratio was higher participants perceived that nurses had more time, energy and ability to meet patient expectation. Implications call for analysis of nurse/patient ratio in relation to patient satisfaction and nurses in relation to patient education as well as patient's perceptions of getting their needs met.School of Nursing
15
Sun, Kwok Wai. "A nursing workload scheduler in an intensive care unit /". Thesis, McGill University, 1994. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=68055.
Testo completoAbstract (sommario):
This thesis presents the design and implementation of an automated task scheduler developed for the Patient Data Management System (PDMS) of the Pediatric Intensive Care Unit of the Montreal Children's Hospital. The principal objective of the Nursing Workload Scheduler (NWS) is to automatically generate schedules for the condition of multiple patients and multiple nurses.This thesis begins with a literature review of computerized medical information systems. It follows with a description of the design and the implementation of the NWS. Evaluation and performance results are then presented and discussed. An outline of future extensions for the system are discussed before the conclusion.
16
Yon, Lauren T. "Integrating mobility into the plan of care in the intensive care unit". Honors in the Major Thesis, University of Central Florida, 2009. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1341.
Testo completoAbstract (sommario):
This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Nursing
Nursing
17
Smith, Sarah, e Sarah Smith. "Compassion Fatigue Among Rural Intensive Care Nurses". Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/626635.
Testo completoAbstract (sommario):
Purpose: The purpose of this project was to conduct an educational workshop among ICU
nurses working in rural areas, to reduce risk of compassion fatigue.
Background: Compassion fatigue is a job-related hazard unique to professionals in caring professions such as nursing. Rural ICU nurses represent a population that may encounter unique triggers for the risk of compassion fatigue due to professional isolation, less resources and more risk of knowing the patient as a community member. A review of literature reveals limited research related to compassion fatigue development in rural ICU nurses.
Method: Two educational workshops were conducted among rural ICU nurses (N=3). Workshop content included discussion about symptoms, triggers, and outcomes of compassion fatigue, as well as positive coping strategies. Participants journaled physical and emotional responses to situations such as ethical or moral dilemmas, boundary issues, and aspects of self-care. Each workshop included time to discuss the educational content and participant experiences; the resulting narratives were analyzed for commonalities.
Findings: Universally, burnout was viewed as inherent to the profession. All participants recounted past traumatic patient encounters that preoccupies their thinking when in similar situations. Symptoms identified as compassion fatigue included chronic, constant, generalized pain, symptoms of depression, isolation, withdrawal and lack of interest in enjoyable activities. Triggers were prolonged patient hospitalizations due to lack of resources, lack of supporting services, lack of leadership support, unexpected patient loss, witnessing patient trauma and grief, caring for patients who did not seem to really need ICU, social situations surrounding patients
10
and floating to different departments. Increased alcohol intake, sarcasm, and venting were the most reported mitigation strategies among participants.
Implications: Compassion fatigue negatively impacts the lives of rural ICU nurses on many dimensions, although it is perceived as inherent to the profession. These participants desired support from nursing leadership and a supportive work environment. Participants expressed they continued to feel compassion, despite experiencing the phenomenon described as compassion fatigue. A less stigmatizing term might better capture the phenomenon now labeled as compassion fatigue.
18
Kean, Susanne. "The emergence of negotiated family care in intensive care : a grounded theory approach". Thesis, University of Edinburgh, 2007. http://hdl.handle.net/1842/2838.
Testo completoAbstract (sommario):
This thesis describes a qualitative enquiry into the experiences of families visiting an adult intensive care unit (ICU) during a critical illness of a family member and nurses’ perceptions of families in this environment. A Grounded Theory approach was taken. Nine families (12 adults, 12 young people) with a family member in intensive care and twenty intensive care nurses in five focus groups contributed their experiences to the study through group interviews. Families described the admission of a family member as a traumatic event. The core experiences of families which emerged in the study revolved around uncertainty. Drawing on Davis’ (1963/1991, 1966) concepts of ‘clinical uncertainty’ and ‘functional uncertainty’ a number of strategies families and young people developed in dealing with the situation were identified. ‘Clinical uncertainty’ captures the unknown and unknowable aspects of critical illness. The ‘Functional uncertainty’ category emerged later in the research process and brings to light management of information disclosure for functional gain as a communication strategy. Functional uncertainty was identified in communications between nurses and families and between parents and children within families. Moreover, young people used the same ‘functional uncertainty’ strategy when disclosing information to peers within the school environment. ‘Keeping normality in life’ and ‘fishing for information’ and the associated strategies were identified as direct responses of young people to clinical and functional uncertainty. The strategies identified provide new insights into how young people process a critical illness event in their families. This emphasises the importance of listening to young people’s voices and the need to include young people in future studies. ‘Nursing in public’ emerged as an overarching theme within the data from nurses’ interviews. The contrasting interests of nurses and families in the context of critical illness became evident when open visiting policies were discussed. The promotion by policy makers and nursing scholars of a patient centred health care service and thus the implicit integration of families into care challenges nurses to adapt their working practices. Whilst this study provides evidence for the importance of integrating families into care it also shows the needs of nurses are in danger of being marginalised. Respecting the needs of families and nurses the question becomes how best to balance the competing needs of both groups. It is suggested that a ‘partnership in care’ approach which is firmly based on negotiations between nurses and families under the leadership of nurses will allow for the emergence of family care in intensive care, to the benefit of patients, families and nurses.
19
Endacott, Ruth. "Children in intensive care : nurses perceptions of need". Thesis, University of Exeter, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.244403.
Testo completoAbstract (sommario):
This study investigates the manner in which intensive care nurses perceive, and take action to meet, the needs of the critically ill child, with the aim of answering three research questions: 1. What care is provided for the critically ill child in the intensive care unit? 2. How do nurses identify and act on the needs of the critically ill child? 3. What dimensionso f knowing underpint he way in which nursesp erceivea nd act on the needs of the critically ill child? A modified Delphi technique was used to provide an expert opinion on the needs of the critically ill child. A case study approach, informed by ethnographic principles, was used to structure observationsa nd interviewsi n one paediatrici ntensivec are unit (ICU) and two general ICUs. Carper's (1978) four dimensions of knowing (aesthetic, ethical, empiricala nd personakl nowing) underpinnedc ases tudy data collectiona nd analysis. The study findings expanded Carper's original work by identifying an additional dimension of knowing, referred to as contextual knowing, which nurses used to relate empirical and aesthetic knowledge to the individual child. This influenced their perception of whether a changed situation constituted a need. The five dimensions of knowing were used in an inter-related way by the nurses; no hierarchy was evident as priority was given to the dimension most relevant in a given situation. The findings highlight the key role of the nurse at the bedside (the allocated nurse) in identifying, legitimising and acting on the needs of the child. The importance of experience and confidence in enabling the nurses to undertake activities such as gate-keeping andprioritising in order to meett he needso f the child was also emphasisedT. he shift leader supported the nurses and co-ordinated the overall activity on the Unit. There was no overall difference in the role adopted by families in the General and Paediatric ICUs. Nursing records were an historical record of care, rather than a plan of care, and did not detail decision-making and prioritising activity frequently observed in the intensive care units. Recommendations are made for strategies to retain experienced nursing staff at the bedside, the active promotion of learning through experience, incorporating prioritising of care in records and a more inclusive framework for measuring and costing nursing workload in ICU
20
Rashotte, Judith Mary. "Pediatric intensive care nurses and their grief experiences". Thesis, University of Ottawa (Canada), 1996. http://hdl.handle.net/10393/10425.
Testo completoAbstract (sommario):
While the phenomenon of grief has received considerable attention and has been researched at length, there is a paucity of literature that has focused on health care professionals' experience of grief. The purpose of this study was to investigate the grief experience of pediatric intensive care nurses when their patients die. A phenomenological method was used in this study in order to obtain rich descriptions of nurses' experience of grief within their workplace. The purposive sample consisted of six registered nurses employed in an intensive care unit in a university-teaching pediatric hospital. In-depth, semi-structured interviews were conducted with the study participants in order to generate the data base. The audio-taped interviews were transcribed and analyzed for recurring themes emerging from the data according to the procedure outlined by Colaizzi. These nurses acknowledged they suffered multiple exposures to children's deaths and experienced grief. The interviews revealed eight themes that included one about their grief responses--hurting; two that described the influencing contextual factors--nurse-family unit relationship and dissonance, and five that related to coping strategies employed to manage their feelings of grief--self-expression, self-nurturance, termination of relationship activities, engaging in control taking activities and self-reflection. Further analysis revealed that managing grief effectively was an experiential learning process for the participants. The resultant themes were compared with the broader literature on grieving the loss of a significant other, grief and the health care professional, and the literature that addressed issues of occupational stress in the care of the critically ill, the dying, and the bereaved. The findings of this study could encourage further research that examines interventions designed to enhance the type of education and support needed in relation to the grief experience of nurses.
21
Taipale, Priscilla Gail. "Nursing care and post-operative delirium in the cardiac surgery intensive care unit". Thesis, University of British Columbia, 2010. http://hdl.handle.net/2429/29278.
Testo completoAbstract (sommario):
Post-operative delirium is a debilitating and costly adverse event that has detrimental effects on patients’ recovery and complicates nursing care. Its numerous risk factors make the disorder seem unavoidable and unpreventable. Although pre-operative and intra-operative risk factors for delirium may not be controllable, the post-operative risk factors directly related to nursing practice are directly controllable. Practices to control pain through analgesia and sedation administration given at nurses’ prerogative may be associated with the onset of delirium in the immediate post-operative period.
This study examined opioid and benzodiazepine administration given pro-re-nata (PRN) (“as needed”) by nurses to cardiac surgery patients to determine whether a relationship exists between delirium and nurses’ drug administration. One hundred twenty-two patients were assessed during the first three days following cardiac surgery for delirium with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Data were collected regarding potential risk factors and opioid analgesia and benzodiazepine dosages given to the patients. A retrospective chart review was conducted to determine whether the patients had a physician’s clinical assessment and diagnosis of delirium.
Post-operative delirium occurred in 37.7% to 44.3% of the study sample, depending on how the cases that had positive CAM-ICU assessments and no clinical diagnoses of delirium were handled. The amount of opioid analgesia given to these patients varied widely; however, the total dosage over the 72-hour study period had no statistically significant relationship with the development of delirium (Median = 77.2 morphine equivalents (MEs) for group without delirium vs. 79.3 MEs for group with delirium; Mann-Whitney U = 1697, Z = -0.72, p = .47). The amount of Midazolam administered also varied widely. There was a statistically significant and positive relationship between the dosage of Midazolam given and the development of post-operative delirium (Median = 2.0 mg. for group without delirium vs. 4.0 mg. for group with delirium; Mann-Whitney U = 1393, Z = -2.31, p = .021).
The results of this study indicate that better nursing education and changes in nurses’ practice may be required to protect patients from experiencing drug-induced post-operative delirium.
22
Williams, Caroline M. A. "Nurse-patient interaction in an intensive care setting". Thesis, University of Brighton, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273868.
Testo completo
23
Bianchi, Elisa A. "The relationship between locus of control and anxiety among intensive care nurses /". Staten Island, N.Y. : [s.n.], 1990. http://library.wagner.edu/theses/nursing/1990/thesis_nur_1990_bianc_relat.pdf.
Testo completo
24
Davies, Kylie. "Determining standard criteria for endotracheal suctioning in the paediatric intensive care patient an exploratory study /". Connect to thesis, 2009. http://adt.ecu.edu.au/adt-public/adt-ECU2009.0001.html.
Testo completo
25
Badger, James Mark. "Nurses' experiences of moving from cure-oriented to comfort-oriented care in the medical intensive care unit setting /". View online ; access limited to URI, 2003. http://0-wwwlib.umi.com.helin.uri.edu/dissertations/dlnow/3115620.
Testo completo
26
Patton, Lauren Ashley. "Education and Standardized Discussion Guides to EnhanceNurses' Spiritual Care Practices in the Medical Intensive Care Unit". Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1519836081431734.
Testo completo
27
Binnekade, Johannes Maria. "Issues of daily ICU nursing care safety, nutrition and sedation /". [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2005. http://dare.uva.nl/document/79050.
Testo completo
28
Borozny, Margaret. "The experiences of intensive care unit nurses providing care to the brain dead patient". Thesis, University of British Columbia, 1990. http://hdl.handle.net/2429/28722.
Testo completoAbstract (sommario):
This study describes the meaning intensive care unit nurses attach to their care of the brain dead patient. A phenomenological methodology was used because of its intent to understand experience as it is lived. Because these patients constitute a unique class of dead patients which require intensive nursing care and because of the scarcity of information available on the subjective experience of nurses who provide this care, the study was considered to be essential to fillful a gap in our knowledge.
Data were collected through 28 interviews with 11 Caucasian female participants who work in the intensive care units of a tertiary and a quaternary care hospital within the greater Vancouver area. Their ages ranged from their early twenties to over forty years of age. They represented five religious demoninations with one participant having no religious affiliations. One nurse had cared for between two and five brain dead patients, four had provided care for six to ten brain dead patients, and six had cared for more than ten brain dead patients.
Throughout the participants' accounts dissonance was the pervasive and unifying theme. The dissonance was seen in the form of either personal or interpersonal discord. The former was seen in relation to five areas: the
participant's philosophy about nursing, traditional nursing care activities, the concept of brain death, organ retrieval and transplantation, and professional responsibilities in relation to meeting the nurse's own emotional needs. In contrast, the latter occurred between the nurse and families, physicians, the Pacific Organ Retrieval for Transplantation Team and nursing colleagues. Either form of dissonance results in personal distress and subsequent attempts to reduce the dissonance by distancing and/or designating another as the target of nursing care.Applied Science, Faculty of
Nursing, School of
Graduate
29
Stadd, Karen. "Initiating Kangaroo Care in the Neonatal Intensive Care Unit". ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5267.
Testo completoAbstract (sommario):
Kangaroo care (KC) is a cost-efficient method to increase infant-parent bonding and neonatal health outcomes worldwide. Despite evidence supporting KC in critically ill infants, nursing perceptions regarding patient safety and interrupted work flow continued to impede practice in the local high-tech neonatal intensive care unit (NICU). Their current policy failed to address the 2-person transfer method recommended for safe practice. In addition, both staff and parents lacked training and education regarding the benefits and feasibility of KC. This doctoral project aimed to decrease practice barriers and promote earlier and more frequent KC by developing and integrating an evidence-based clinical pathway within a multifaceted champion-based simulated educational training program for NICU staff and parents. Published outcomes and generated organizational data for program synthesis connected the gap in practice. Kolcaba's comfort theory served as the guiding framework to ensure a partnership in care. This quasi-experimental quantitative study used the generalized liner model for data analysis. Study findings indicated that KC occurred 2.4 more times after the intervention compared to before (p = 0.001). Descriptive data revealed that KC episodes for intubated patients nearly doubled after implementation (11.1% from 6.2%). Post-survey scores for nursing knowledge and comfort level also improved after the intervention. Although earlier KC practice was non-conclusive (p = 0.082), future trials should control groups for day of life since admission. Disseminating the KC pathway can have a positive social change on family-centered care by increasing NICU nurses' knowledge, comfort, and adoption of this evidence-based practice as an expected routine standard of care.
30
Mosavian, Pour Mir Kaber. "Learning and quality improvement : nursing in the pediatric intensive care unit". Thesis, University of British Columbia, 2017. http://hdl.handle.net/2429/63141.
Testo completoAbstract (sommario):
Maintaining a high quality of care in a Pediatric Intensive Care Unit (PICU) is a constant challenge. Continual 24/7 staffing, ongoing staff turnover, and the constant introduction of new equipment and procedures in a highly technologically-dependent unit requires continuous learning to deliver and improve the quality of children’s care. While all staff consider continuous learning important to maintaining and improving care, learning as quality improvement is made most explicit when new nursing staff are hired and incorporated into the PICU.
In this dissertation, I investigated the process of learning by individuals in the interactive social environment of the PICU to answer the following questions: How does learning occur among the newly hired nurses in the PICU? And, how does learning contribute to quality improvement? In this mixed method inquiry, I employed ethnography, Social Network Analysis and simple descriptive and inferential statistical methods to explore process of learning among the newly hired nurses in Western Canada Hospital.
I found that learning among newly hired nurses happened through face to face interactions in the context of two main activities: Orientation sessions and their Preceptorship. The most significant learning for the newly hired nurses, however, happened during their Preceptorship. Learning in the Preceptorship was social and experiential as they moved from legitimate peripheral participation in the multi-disciplinary and complementary social environment of the PICU into full participation as members of the PICU Community of Practice (CoP). This learning required the transformation and development of their individual and collective identity, as their preceptors, fellow nurses, and other staff employed scaffolding to mentor them through their constantly evolving Zone of Proximal Development (ZPD). Social and experiential learning activities became the basis for continuous quality improvement (CQI).
I conclude that, in the PICU, quality improvement is the tangible manifestation and product of social and experiential learning. Rather than a sequence of corrective actions, in its most effective form, quality of care is improved through scaffolded ongoing learning activities in the authentic setting of a CoP. I recommend the unit to adopt a “learning together” sociocultural approach with scaffolding as key component for successful learning and CQI.Medicine, Faculty of
Experimental Medicine, Division of
Medicine, Department of
Graduate
31
Lovejoy-Bluem, Arlene. "Neonatal Intensive Care Unit Discharge Transitioning| Nursing Practices, Perspectives, and Perceptions". Thesis, Brandman University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3665293.
Testo completoAbstract (sommario):
The American Academy of Pediatrics (AAP) delineated four criteria for management of perinatal care and discharge (DC) of high-risk neonates: 1) physiological stability, 2) tracking and surveillance of growth and development for each infant, 3) active parental involvement with the infant's care, and 4) follow-up care arranged with experienced primary care provider. Registered Nurses in California Neonatal Intensive Care Units (NICUs) were surveyed about NICU DC transitioning programs to 1) identify current common standards of care used in DC transitioning and 2) define the nature and extent of additional criteria and procedures used in DC transitioning. Useable surveys were obtained from 32 of the 79 facilities queried (41%): 17 (53%) Level II, 10 (31%) Level III, and 5 (16%) Level IV. All responding facilities were located in communities of 100,000 people or more. All but one of the facilities (97%) used all four AAP criteria for determining readiness for DC. Facilities differed in whether they also used weight, corrected gestational age, or both as criteria for DC. They differed in the definition of active parental involvement with care, the degree to which parents participated in DC planning, who arranged for post-DC primary care, and how outcomes of DC planning practices were evaluated. Profiles derived from these data can be used to expand procedures, guidelines, and policies for DC transitioning of the NICU graduate.
32
Jacob, Yanick. "Nursing Knowledge on Pressure Injury Prevention in the Intensive Care Unit". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7810.
Testo completoAbstract (sommario):
Over 60,000 hospital patients die each year from complications associated with hospital-acquired pressure injuries (HAPIs). Pressure-injury rates have increased by 2% within the past decade as life expectancy has also increased due to high cost in Medicare. Evidence shows that the incidence of pressure injuries (PIs) in healthcare facilities is increasing, with high rates of occurrence in intensive care units (ICUs). At the clinical site for which this project was developed, multiple in-services had been provided to staff regarding PIs, but uncertainty persisted about how knowledgeable the nurses were. This project, using the Academic Center for Evidence Star Model of Knowledge Transformation improved the nurses' knowledge and their practice related to PI prevention in the ICU, as well as to translate evidence into nursing practice. A literature review was conducted on PI prevention to inform the project. The project provided an educational program for intensive care nurses on PI prevention and determined, based on participants' pre- and posttest responses, that nurses' knowledge improved as a result of participation. This project, involving 55 nurses, includes information on the Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT) measuring pressure knowledge which resulted in an 85% improvement on injury prevention, 76% in wound description, as well as, 62% in the Braden Scale. Improvements in knowledge and practice resulting from nurses' participation in an evidence-based education session on PI prevention may bring positive social change to the organization at which this project was conducted.
33
Coyer, Fiona Maree. "The Development of Family-Focused Intensive Care Nursing Through Action Research". Thesis, Queensland University of Technology, 2004. https://eprints.qut.edu.au/15932/1/Fiona_Coyer_Thesis.pdf.
Testo completoAbstract (sommario):
Introduction:
The purpose of this study was to facilitate an improved understanding by intensive care nurses about their care of family members of critically ill patients. The study aimed to challenge intensive care nurses to reconceptulaise family nursing within the context of the intensive care unit (ICU).
Background to the study:
Critical illness is not an event that occurs in isolation for the patient and staff. It affects the patient's family in a unique way. A plethora of literature exists identifying the needs of family members in the ICU. However, there are considerably fewer studies which have examined interventions to meet family members' needs and no identified research that discreetly examined the concept of family-focused nursing in the intensive care environment.
Design of the study:
This study utilised a collaborative action research methodology. It was developed in four phases through the cyclical, dynamic steps of action research.
Setting:
This study was undertaken in the general intensive care facility of a metropolitan tertiary referral hospital.
Phase One:
Phase One of the study was the establishment of a collaborative action research group (CARG) with interested registered nurses working in a general intensive care unit. The CARG explored the first two research questions of this study: 1) What are intensive care nurses' perceptions of family-focused nursing? and 2) Is familyfocused nursing appropriate in the intensive care environment? Data were collected through audio taping meetings, flip chart notes and the researcher's reflective diary. Data analysis was undertaken utilising open coding. For the first research question, open coding of the data revealed two categories relating to perceptions of family focused intensive care nursing: partnership in care and maintaining a balance. For the second research question, CARG members agreed unanimously that family focused nursing was appropriate in the intensive care environment. The CARG determined future direction of the action research phases, commencing with a family needs analysis in Phase Two.
Phase Two:
Phase Two of the study was the utilization of a descriptive survey to determine family member needs in the ICU to determine focuses for interventions during Phase Three. Both family members and staff in the ICU were surveyed utilising the Critical Care Family Needs Index (CCFNI) (Molter & Leske, 1983). Data were analysed by the CCFNI subcategories of assurance, proximity, information, comfort and support, comparing means, rank ordering of means and t-test for statistically significant differences in means between the family members and staff participants. Results indicated that statistically significant differences in means scores between family members and staff participants were in the CCFNI categories of assurance, proximity, information and support. On the basis of these results, a platform for Phase Three of this study arose. The areas for intervention for Phase Three were identified by the CARG as: the provision of staff education seminars to raise staff awareness of family needs and the development of a structured family assessment tool to identify family needs in the ICU.
Phase Three:
Phase Three of the study addressed research question three: "How can intensive care nurses provide care that is focused toward the family of the critically ill patient?" Phase Three examined practice interventions in two areas. Phase Three Part A was the implementation of nursing staff education seminars. Forty-two nursing staff participated in the family needs education seminars. Data were collected by detailed researcher field notes and completion of a descriptive survey, the CCFNI, post seminar attendance. Thirty-five participants completed the CCFNI. This CCFNI data from nursing participants in the education seminars was compared to family members CCFNI data from Phase Two. Open coding of data from the education seminars revealed codes of family needs, visiting, family presence, encouragement, simple things and boundaries under the theme of "establishing the context" and attitudes, confidence, empathy and culture under the theme of "building a partnership". CCFNI results highlighted statistically significant differences in means scores between family members and staff participants were in the subcategories of proximity and support. Results demonstrated that through understanding family members needs that intensive care nurses can provide care that is focused toward the family of the critically ill patient. This is a building process to be achieved over time. Phase Three Part B was the content validity development of a family assessment tool for the Computer Information System (CIS) in the ICU. A family assessment tool (See Figure 6.1) was developed through the literature and in consultation with the CARG. A series of focus groups were organised. All nursing staff in the general ICU were invited to participate. Twenty-nine registered nurses (43.9%, n=66) participated in the family assessment tool focus groups. The five domains of the family assessment tool, family roles, family spokesperson, family perception and coping, family issues and family health needs, were each discussed to determine readability, clarity and applicability. The focus groups agreed on content validity of the family assessment tool. (See Figure 6.2).
Phase Four:
Finally, Phase Four of the study has addressed research question four: "Is action research an appropriate methodology to transform intensive care nursing practice?" Somekh's (1995) framework was utilised to guide this critical evaluation. It is suggested that action research is an appropriate methodology to transform intensive care nursing practice as it enables the development of professional, it is sensitive to the specific nature of intensive care nursing, it acknowledges of attributes of the researcher in the process. It is also an appropriate methodological choice as it provides opportunity for a critical evaluation and a platform for the ongoing nature of the action research journey.
Conclusions:
Overall the findings achieved the objectives of the study in that organisational, cultural and clinical practice changes were identified to facilitate family-focused intensive care nursing. Collaboration occurred with intensive care nurses to effect change. The action research process involved in the change process was articulated throughout the four phases of the study. An improved understanding by intensive care nurses about their family nursing practice was demonstrated in Phase Three and the efficacy of action research methodology for clinical practice change was demonstrated in Phase Four.
34
Coyer, Fiona Maree. "The Development of Family-Focused Intensive Care Nursing Through Action Research". Queensland University of Technology, 2004. http://eprints.qut.edu.au/15932/.
Testo completoAbstract (sommario):
Introduction: The purpose of this study was to facilitate an improved understanding by intensive care nurses about their care of family members of critically ill patients. The study aimed to challenge intensive care nurses to reconceptulaise family nursing within the context of the intensive care unit (ICU). Background to the study: Critical illness is not an event that occurs in isolation for the patient and staff. It affects the patient's family in a unique way. A plethora of literature exists identifying the needs of family members in the ICU. However, there are considerably fewer studies which have examined interventions to meet family members' needs and no identified research that discreetly examined the concept of family-focused nursing in the intensive care environment. Design of the study: This study utilised a collaborative action research methodology. It was developed in four phases through the cyclical, dynamic steps of action research. Setting: This study was undertaken in the general intensive care facility of a metropolitan tertiary referral hospital. Phase One: Phase One of the study was the establishment of a collaborative action research group (CARG) with interested registered nurses working in a general intensive care unit. The CARG explored the first two research questions of this study: 1) What are intensive care nurses' perceptions of family-focused nursing? and 2) Is familyfocused nursing appropriate in the intensive care environment? Data were collected through audio taping meetings, flip chart notes and the researcher's reflective diary. Data analysis was undertaken utilising open coding. For the first research question, open coding of the data revealed two categories relating to perceptions of family focused intensive care nursing: partnership in care and maintaining a balance. For the second research question, CARG members agreed unanimously that family focused nursing was appropriate in the intensive care environment. The CARG determined future direction of the action research phases, commencing with a family needs analysis in Phase Two. Phase Two: Phase Two of the study was the utilization of a descriptive survey to determine family member needs in the ICU to determine focuses for interventions during Phase Three. Both family members and staff in the ICU were surveyed utilising the Critical Care Family Needs Index (CCFNI) (Molter & Leske, 1983). Data were analysed by the CCFNI subcategories of assurance, proximity, information, comfort and support, comparing means, rank ordering of means and t-test for statistically significant differences in means between the family members and staff participants. Results indicated that statistically significant differences in means scores between family members and staff participants were in the CCFNI categories of assurance, proximity, information and support. On the basis of these results, a platform for Phase Three of this study arose. The areas for intervention for Phase Three were identified by the CARG as: the provision of staff education seminars to raise staff awareness of family needs and the development of a structured family assessment tool to identify family needs in the ICU. Phase Three: Phase Three of the study addressed research question three: "How can intensive care nurses provide care that is focused toward the family of the critically ill patient?" Phase Three examined practice interventions in two areas. Phase Three Part A was the implementation of nursing staff education seminars. Forty-two nursing staff participated in the family needs education seminars. Data were collected by detailed researcher field notes and completion of a descriptive survey, the CCFNI, post seminar attendance. Thirty-five participants completed the CCFNI. This CCFNI data from nursing participants in the education seminars was compared to family members CCFNI data from Phase Two. Open coding of data from the education seminars revealed codes of family needs, visiting, family presence, encouragement, simple things and boundaries under the theme of "establishing the context" and attitudes, confidence, empathy and culture under the theme of "building a partnership". CCFNI results highlighted statistically significant differences in means scores between family members and staff participants were in the subcategories of proximity and support. Results demonstrated that through understanding family members needs that intensive care nurses can provide care that is focused toward the family of the critically ill patient. This is a building process to be achieved over time. Phase Three Part B was the content validity development of a family assessment tool for the Computer Information System (CIS) in the ICU. A family assessment tool (See Figure 6.1) was developed through the literature and in consultation with the CARG. A series of focus groups were organised. All nursing staff in the general ICU were invited to participate. Twenty-nine registered nurses (43.9%, n=66) participated in the family assessment tool focus groups. The five domains of the family assessment tool, family roles, family spokesperson, family perception and coping, family issues and family health needs, were each discussed to determine readability, clarity and applicability. The focus groups agreed on content validity of the family assessment tool. (See Figure 6.2). Phase Four: Finally, Phase Four of the study has addressed research question four: "Is action research an appropriate methodology to transform intensive care nursing practice?" Somekh's (1995) framework was utilised to guide this critical evaluation. It is suggested that action research is an appropriate methodology to transform intensive care nursing practice as it enables the development of professional, it is sensitive to the specific nature of intensive care nursing, it acknowledges of attributes of the researcher in the process. It is also an appropriate methodological choice as it provides opportunity for a critical evaluation and a platform for the ongoing nature of the action research journey. Conclusions: Overall the findings achieved the objectives of the study in that organisational, cultural and clinical practice changes were identified to facilitate family-focused intensive care nursing. Collaboration occurred with intensive care nurses to effect change. The action research process involved in the change process was articulated throughout the four phases of the study. An improved understanding by intensive care nurses about their family nursing practice was demonstrated in Phase Three and the efficacy of action research methodology for clinical practice change was demonstrated in Phase Four.
35
Romesberg, Tricia L. "Midline Catheter Use in the Newborn Intensive Care Unit". UNF Digital Commons, 2014. http://digitalcommons.unf.edu/etd/544.
Testo completoAbstract (sommario):
Ongoing evaluation of current practice and incorporation of evidence based research into guidelines and protocols is a requirement for the provision of high quality, cost efficient care. Despite some literature describing observational data, midline catheters (MCs) are not an appropriate vascular access device for Newborn Intensive Care Unit (NICU) patients due to insufficient high level evidence demonstrating safety and efficacy. In addition, national guidelines for MC use in neonatal and infant patients lacks sufficient information for safe and effective use of MCs.
The results of this small, online survey indicate that while some neonatal nurses and Nurse Practitioners report the use of MC use in the NICU, there is a wide range of practice pertaining to MC unit-specific protocols, competencies, success with placement, and clinician agreement of appropriate use for this vascular access device (VAD). Multicenter, randomized control trials are needed to evaluate current MC practice in the NICU, and institutions must incorporates current, evidence based practice into policies, procedures, and guidelines.
36
Sato, Michelle N. "Nurse Experiences of Grief and Coping in the Intensive Care Unit". Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/578617.
Testo completoAbstract (sommario):
Background: Intensive care unit (ICU) nurses may experience cumulative loss as they are routinely exposed to traumatic situations, patient suffering, and death. They must also deal with personal grief and grief of patients' family in a time of uncertain crisis. Currently, there is minimal literature that acknowledges grieving and coping in the ICU. The grief and coping experiences of medical intensive care unit (MICU) nurses is little understood. Purpose: Explore grief and coping amongst registered nurses working in the MICU at a major metropolitan hospital in Hawaii. Method: A qualitative descriptive approach was used. Open-ended interviews and a brief demographic questionnaire were used to collect data from five registered nurses who work in the MICU. A pragmatic approach to qualitative data analysis was used. Results: The findings of this study are presented in two main categories: grief and coping. Subthemes of grief are further described in the following categories: 1) circumstance of death; 2) keeping professional boundaries; 3) being supported; and 4) learning from experience. Coping is addressed by describing the main methods used by the nurse participants. Coping includes: 1) talking and being heard; 2) finding a support system; 3) using humor; and 4) spirituality. Findings suggest that MICU nurses have unique grief experiences and their coping is individualized. The nurses are aware of the effects grief has on their personal and professional lives. Additionally, they all seem to have developed effective coping habits to manage grief. Conclusion: There is no single method to manage grief responses. However, there is a level of mutual understanding of experiencing death in the MICU, which yields support and camaraderie amongst MICU nurses. Further research is needed to explore differences in other ICUs.
37
Tingling, Louis Gilbert. "Root Cause of Medication Errors In a Pediatric Intensive Care Unit". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7201.
Testo completoAbstract (sommario):
Five to 27% of all pediatric medication orders lead to errors and play a significant role in the morbidity and mortality of the pediatric patients admitted to hospitals. The practice problem explored the high rate of medication errors in the pediatric intensive care unit (PICU) of the project site, where the population is particularly vulnerable due to their acute illnesses. The purpose of this project was to analyze the root causes of all cases of medication error in this hospital's PICU during the last 2 years. The literature review was used to categorize secondary data extracted from the hospital's quality assurance database. An analysis of the 41 total medication errors showed that 49% of the medication errors made in the PICU were due to the nurse administering the incorrect dose of medication. Most (60%) occurred on the day shift when the unit was busy and the patient's medication orders were constantly being changed. Missed doses' mostly due to oversight and ineffective follow-up by clinical staff, pharmacy, and providers accounted for 27% of the medication errors. There were instances in which the physician and the pharmacy did not properly order and verify a medication. The summary of the root cause analysis and recommendations from the literature for improved clinical practice will be presented through the hospital's quality assurance structure. Recommendations include implementing computerized physician order entry, regular education of staff, involvement of the pharmacist in new medication orders, updated nursing protocols, and support systems for decision making. The implications of this project for positive social change include the impact of improved practices on decreasing medication errors and improving health outcomes in the PICU population.
38
Van, der Heever Mariana. "An ideal leadership style for unit managers in intensive care units of private health care institutions". Thesis, Stellenbosch : University of Stellenbosch, 2009. http://hdl.handle.net/10019.1/4058.
Testo completoAbstract (sommario):
Thesis (MCur (Nursing Science))--University of Stellenbosch, 2009.ENGLISH ABSTRACT: The work environment in critical care units in South Africa is hampered by a profound shortage of nurses, heavy workloads, conflict, high levels of stress, lack of motivation and dissatisfaction among the staff. The task of managing a C.C.U. has therefore become a challenge. It is important that unit managers apply a leadership style that matches these challenges. The aim of this study was to investigate the ideal style of leadership. The objectives set for the study were to identify the ideal leadership style required in the following areas: administrative functions education functions patient care research An explorative, descriptive research design was applied, with a quantitative approach to determine the ideal leadership style for unit managers in critical care units of private health care institutions. The research sample consisted of all nurses working permanently in eleven private hospitals in the Cape Metropolitan area. A questionnaire consisting of predominantly closed questions was used for the collection of data, which was collected by the researcher in person. Ethical approval was obtained from the Committee of Human Science Research at Stellenbosch University. Permission to conduct the research was obtained from the institutions and informed consent from the participants. A pilot study was conducted to test the questionnaire at a private hospital which did not form part of the study. A 10% sample of the relevant staff, namely 27 participants were involved in this study. The validity and reliability was assured through the pilot study and the use of a statistician as well as experts in nursing and a research methodologist. Data was tabulated and presented in histograms and frequencies. Statistical significant associations were drawn between variables, using the Chi-square test. The Spearman rank (rho) order correlation was used to show the strength of the relationship between two continuous variables. Findings of the study show that participatory leadership style and transformational leadership approach were valued in all four (4) of the objectives. Emphasis was placed on consultation prior to any decisions. Nurses requested an opportunity to give feedback on a regular basis regarding the unit managers conduct (Chi-square test p = 0.025). They also agreed that unit managers should apply the necessary rules and procedures (Chi-square test p = 0.016). A huge request was made for integrity, trust, impartiality, openness, approachability and particularly honesty. The nurses also maintained that the nurse manager’s behaviour should be congruent. Furthermore, the results indicate that nurses would like to be empowered by: being involved in the scheduling of off-duties taking the lead in climate meetings being granted opportunities (to all categories of nurses) to attend managerial meetings. N = 41 (48.2%) of nurses admitted that unit managers would instruct them to cope with insufficient staffing pertaining to ventilated patients, putting them under severe strain and at risk legally. N = 39 (47%) of nurses admitted that unit managers only consider qualifications and experience in the delegation of tasks if the workload in the unit justifies it. Safe patient care is not always a priority. N = 99 (96%) of nurses agreed that autocratic behaviour relating to task delegation exists. Recommendations included the application of transformational leadership and participatory management. The aim to create a healthier, more favourable work environment for critical care nurses will hopefully be attained through applying the ideal leadership style and leadership approach.
AFRIKAANSE OPSOMMING: Die werksverrigtinge in kritieke sorgeenhede in Suid-Afrika word deur ‘n ernstige tekort aan verpleegsters, hoë werklading, konflik, spanning, min motivering en baie ontevredenheid onder verpleeglui gekortwiek. Die leiding en bestuur van ‘n kritieke sorgeenheid is dus nie ‘n maklike taak nie. Dit is dus belangrik dat eenheidsbestuurders ‘n leierskapstyl aan die dag lê wat dié uitdagings doeltreffend aanspreek. Die doel van die studie is dus om ondersoek in te stel na die wenslike leierskapstyl vir kritieke sorgeenhede. Die doelwitte daargestel is dus om die ideale leierskapstyl in elk van die volgende funksies te bepaal: administrasie opleiding pasiënte-sorg navorsing Die ideale leierskapstyl vir eenheidbestuurders in kritieke sorgeenhede in privaathospitale is bepaal deur ‘n kwantitatiewe benadering met ‘n beskrywende ontwerp toe te pas. Die populasie het alle kritieke sorg verpleeglui ( permanent werksaam by een van elf privaathospitale in die Kaapse Metropool) ingesluit. Instrumentasie het ‘n vraelys behels (met oorwegend geslote vrae) en data is persoonlik deur die navorser ingevorder. Etiese toestemming is vanaf die Etiese Komitee van die Mediese Fakulteit te Universiteit Stellenbosch verkry asook die hoofde van die verskillende privaathospitale waar navorsing plaasgevind het. Ingeligte toestemming is ook van elkeen van die deelnemers verkry. Ten einde die vraelys te toets, is ‘n loodstudie by ‘n privaathospitaal ( wat nie by die studie ingesluit was nie) gedoen. Die loodstudie het N = 27 (10%) van die totale populasie behels. Die betroubaarheid en geldigheid van die studie is deur die loodstudie, die gebruik van ‘n statistikus, verpleegdeskundiges en die navorser-metodoloog versterk. Data is getabuleer en in histogramme en frekwensies voorgestel. Deur die Chi-square- toets te gebruik, is statisties betekenisvolle assosiasies tussen veranderlikes bepaal. Ten einde sterkte van verhoudings tussen twee opeenvolgende veranderlikes te bepaal, is die Spearman rangordekorrelasie (rho) aangewend. Die bevindings van die studie het getoon dat ‘n deelnemende bestuurstyl en transformasie-leierskapbenadering die mees aangewese keuse vir al vier doelwitte is. Die toepassing van veral ‘n deelnemende besluitnemingsproses het groot voorrang geniet, Verpleegkundiges wil daarbenewens ook op ‘n gereelde basis geleentheid hê om terugvoering oor die leierskapgedrag van die eenheidsbestuurder te gee (Chi-square toets p = 0.025). Ook verlang die deelnemers dat eenheidsbestuurders nie reëls en regulasies moet verontagsaam nie (Chi-square toets p = 0.016). ‘n Ernstige versoek is gerig ten opsigte van integriteit met pertinente verwysing na eerlikheid, vertroue, onpartydigheid, deursigtigheid, toeganklikheid en dat die leier se woorde en dade moet ooreenstem. Die resultate het verder getoon dat verpleegsters graag bemagtig wil word deur: betrokkenheid in die skedulering van afdienste, leiding in klimaatsvergaderings te wil neem, geleentheid te hê om bestuurvergaderings by te woon (alle kategorieë van verpleegkundiges).. N = 39 (48.2%) van verpleegkundiges het erken dat hulle gedwonge personeeltekorte ten opsigte van geventileerde pasiënte ervaar en dus aan mediese geregtelike risiko’s en onnodige druk blootgestel word. N 39 (47%) van verpleegkundiges het erken dat eenheidsbestuuders kwalifikasies en ondervinding slegs in ag neem indien die werklading in die eenheid dit toelaat..Veilige pasiëntesorg kry dus nie altyd voorkeur nie. N = 99 (96%) van verpleegkundiges het erken dat outokratiese gedrag ( wat met werkstoewysing verband hou) wel voorkom. ‘n Transformasie leierskapsbenadering en deelnemende bestuurstyl is dus aanbeveel. Die hoop word dus uitgespreek dat deur aan die verpleegkundiges se versoeke ten opsigte van die ideale bestuursbenadering en bestuurstyl te voldoen, die werksatmosfeer binne kritieke sorgeenhede toenemend gesonder en dus aangenamer sal word.
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Palmer, Lydia Helmick. "Prevention of Skin Breakdown in the Pediatric Intensive Care Unit". Thesis, University of South Carolina, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3561837.
Testo completoAbstract (sommario):
Skin breakdown occurs when one or more layers of the skin have been disrupted (McLane et al., 2004; National Pressure Ulcer Advisory Panel, 2007). While some literature uses the terms skin breakdown and pressure ulcer interchangeably, these are actually two distinct conditions and pressure ulcers are encompassed in the definition of skin breakdown (Kuller, 2001; Lund, 1999; Suddaby et al., 2006). The consequences of skin breakdown in the pediatric population can include increased cost of treatment, infection, increased morbidity and mortality as well as psychological consequences from resulting alopecia or scarring (Schindler, 2010; Willock & Maylor, 2004). Development of skin breakdown has also been associated with increased morbidity, increased length of stay, and higher costs of care (McCord et al., 2004).
Prevention of skin breakdown can be accomplished by the use of barriers and specialty surfaces. Barrier protection is achieved by the use of preparations, such as zinc oxide, petrolatum-containing compounds, and alcohol-free barrier films, and also by the application of transparent film and hydrogel dressings (Atherton, 2004; Atherton, 2005; Baharestani, 2007; Campbell et al., 2000; Lund et al., 2001). Surfaces can be useful in the prevention of skin breakdown by aiding in the distribution of pressure and decreasing moisture, and can also be used to aid in temperature control for some patients (Norton, Coutts, & Sibbald, 2011). The PICO format question used to guide this project is: For patients in Pediatric Intensive Care Units, is barrier protection or use of specialty surfaces more effective at preventing skin breakdown?
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Vandergoot, Ann. "From ward nurse to proficient critical care nurse a narrative inquiry study : a dissertation [thesis] presented in partial fulfillment of the degree of Master of Health Science, 2005". Full thesis. Abstract, 2005.
Cerca il testo completoAbstract (sommario):
Thesis (MHSc--Health Science) -- Auckland University of Technology, 2005.Appendices not included in e-thesis. Also held in print (65 leaves, 30 cm.) in Akoranga Theses Collection. (T 610.730690993 VAN)
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Archer, Susan. "Caring for Patients with Delirium in the Intensive Care Unit". ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3744.
Testo completoAbstract (sommario):
Patients in hospital intensive care units are at increased risk to develop delirium, a condition which is characterized by a disturbance of consciousness and a change in cognition. Critical care nurses must have the knowledge to assess, recognize, and manage delirium. The purpose of this project was to develop an evidence-based policy for the assessment of delirium and a comprehensive nursing education plan which included an analysis and synthesis of the literature, a curriculum plan, and a pretest/posttest. The Johns Hopkins Evidence-Based Practice Model framed the project, which used a multidisciplinary team approach. Two nursing leaders, each with a doctor of philosophy degree, served as content experts for the educational curriculum plan and the pretest/posttest. The curriculum plan was evaluated using a dichotomous scale of 1 = not met and 2 = met. An average score of 2 was achieved showing the content met the objectives. The pretest/posttest items were validated using a Likert-type scale ranging from 1 = not relevant to 4 = very relevant. A content validation index score of 1.0 was computed, revealing that the items met the objectives and content of the curriculum. The pretest/posttest was administered before and after the educational program to determine the knowledge gained. A paired samples t test was conducted and found to have a statistically significant difference in the scores for the pretest (M = 81.25, SD = 11.29) and post-test (M = 94.06, SD = 7.12); t (31) = -5.92, p = 0.01, revealing that the critical care nurses gained significant knowledge with the delirium educational program. This project can promote positive social change because early recognition and management of the patient with delirium can facilitate positive outcomes for patients, families, and systems.
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Ferrel, Cynthia Lynn. "The experience of critical care nurses in initiating hospice care". abstract and full text PDF (free order & download UNR users only), 2008. http://0-gateway.proquest.com.innopac.library.unr.edu/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1453534.
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Alalyani, Mesheil M. "Factors influencing the quality of nursing care in an intensive care unit in Saudi Arabia". Thesis, Curtin University, 2011. http://hdl.handle.net/20.500.11937/2632.
Testo completoAbstract (sommario):
Quality care in intensive care units is expected by patients and is mandatory for nurses and other health professionals to provide. In Saudi Arabia, the demand for intensive care units (ICUs) is growing rapidly, partly due to the high levels of road trauma and a population increase. In response to these issues, the government has increased the number of ICU beds in some public tertiary regional hospitals. A corresponding increase in patients and a shortage of specialized nurses has major implications for nurses’ ability to provide quality care. In the Western world there is comprehensive literature related to research and factors that influence nursing care. To date, however, no such study has been conducted in an ICU in Saudi Arabia. The purpose of this study was, therefore, to explore and describe factors that influence nursing care in a Saudi Arabian ICU. Additionally, since clinical governance has been described as a structured system for promoting quality care and health service planning, a further aim was to describe the findings within this framework.This study employed a single exploratory descriptive case study using a qualitative approach. Data were collected from various sources with thematic analysis being used to establish themes that emerged from the data. The proposition taken in this case study was that multiple factors influence the quality care registered nurses provide in an ICU setting. It was an assumption that these factors would be both internal and external to the ICU. Findings from this study concurred with this assumption uncovering multiple, complex and interrelated factors that influenced the quality of nursing care in the ICU. It also uncovered factors which were located in the conduit between the internal and external environment: namely intermediate factors. The environment was seen as: direct factors that immediately affected nurses and their ability to provide quality care; intermediate factors were those that encapsulated regular, but intermittent elements; and indirect factors related to elements external to the ICU. Within each of these categories themes and sub-themes emerged. Themes in the direct factors were Continuance: with sub themes of Shift work arrangement, Workload, Collegiality, and Unit management. Burden of responsibility: with sub themes of Educational preparation and Availability of Resources. Proximity: emerged as a theme which related to being close contact with patients.Themes in the intermediate factors were: Relationships with superiors, as well as Policies and protocols. Themes in the indirect factors were: Leadership and bureaucracy, Quality management, and Ongoing education. Together these factors had a profound influence on the quality of nursing care in the ICU. Some had distinctive characteristics whilst others overlapped and were interrelated clarifying and explaining aspects of the complex open system in which nursing care was provided. It is anticipated that these findings will not only have relevance to the ICU in the setting, but also to other hospitals in the Saudi Arabian health care system.
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Ashcraft, Alyce Louise Smithson. "The clinical reasoning of expert acute care registered nurses in pre-cardiopulmonary arrest events". Thesis, Full text (PDF) from UMI/Dissertation Abstracts International, 2001. http://wwwlib.umi.com/cr/utexas/fullcit?p3008269.
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Vanderspank, Brandi. "The Social Construction of Intensive Care Nursing, 1960-2002: Canadian Historical Perspectives". Thèse, Université d'Ottawa / University of Ottawa, 2014. http://hdl.handle.net/10393/30922.
Testo completoAbstract (sommario):
Intensive care units (ICUs) emerged across Canada during the early 1960s, significantly contributing to the image of Western hospitals as places of scientific advancement that predominated over much of the twentieth century. ICUs rapidly became both a resource intensive and expensive type of care as the number and size of units increased to accommodate diverse patient populations and treatment options. Nurses enabled the formation and growth of ICUs through their constant presence and skilled care. There has been limited research, however, regarding the historical development of Canadian ICUs, the relationships between nurses and other personnel in such units, how they developed an identity as ICU nurses, or how ICU nursing became a specialty practice.
Situated within the broader histories of hospitals, healthcare, and nursing, this study uses a social history approach to examine nurses’ experiences within Canadian ICUs between 1960 and 2002. Berger and Luckmann’s Social Construction of Reality provided a lens for analysis and interpretation of oral histories, photographs, professional literature of the time period under study, and both archival and organizational records. This thesis argues that ICU nurses’ relationships with one another, in the context of a technologically complex environment, socially constructed their knowledge and skill acquisition, their socialization as ICU nurses, and the development of a specialized body of knowledge that ultimately led to formal recognition of ICU nursing as a specialty in Canada.
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Oraka, Ebele. "Early Detection of Neonatal Abstinence Syndrome by Neonatal Intensive Care Unit Nurses". ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5580.
Testo completoAbstract (sommario):
Neonatal abstinence syndrome (NAS) is a public health concern that is increasing in the United States due to the use of illicit drugs by pregnant women, which exposes the fetus to these substances. NAS results in increased infant morbidity and prolonged stay in the hospital, which can lead to increased cost of care. The inability of the nurses to care for at-risk infants can lead to inconsistent NAS scores, which can affect the infant's care treatment. The project examined the effectiveness of educating the neonatal intensive care unit (NICU) nurses on the correct use of the modified Finnegan Neonatal Abstinence Tool (FNAST) and implementing a practice protocol in the management of infants experiencing NAS, thereby reducing inconsistencies in NAS scores. Implementing clinical guidelines and proper use of the modified FNAST can lead to early intervention and treatment of infants exhibiting withdrawal symptoms. An educational session was conducted, pretests and posttests were used to evaluate the NICU nurses' baseline knowledge of the correct use of the modified FNAST and their acquired knowledge after the educational intervention on the correct use of the modified FNAST. The goal of the project was met with the NICU nurses experiencing knowledge gain evidenced by a 30% increase between the pretests and posttests and obtaining consistent NAS scores by applying the correct technique of scoring. The mastery of the use of the modified FNAST brought about social change by impacting positive attitudes and behaviors among the NICU nurses and enhancing collaboration between the physicians and nurses.
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Farr, Shirley Marie. "A developmental care program in the Neonatal Intensive Care Unit at Arrowhead Regional Medical Center". CSUSB ScholarWorks, 2005. https://scholarworks.lib.csusb.edu/etd-project/2741.
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Chard, Jennifer Clarissa 1963. "Professional nursing practice in medical-surgical and intensive care units: Baseline comparisons". Thesis, The University of Arizona, 1990. http://hdl.handle.net/10150/278593.
Testo completoAbstract (sommario):
This study had three purposes: (1) to examine the differences and similarities between intensive care and medical-surgical RNs' self-reports of professional nursing practice and job satisfaction. (2 & 3) to explore the influence of professional nursing practice on nurse satisfaction in intensive care RNs and medical-surgical RNs, respectively. A two-group, cross-sectional descriptive design with a sample of 340 RNs was utilized to perform a secondary analysis of baseline data from the Differentiated Group Professional Practice project. Self-reports of RNs evidenced significantly higher levels of autonomy and control over nursing practice among intensive care subjects as opposed to medical-surgical subjects. The concepts of organizational commitment, autonomy, control over nursing practice, and group cohesion had a positive influence on total job satisfaction for the medical-surgical subjects. The above concepts with the exception of autonomy had a positive influence on total job satisfaction for the intensive care subjects.
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Coombs, Maureen A. "Medicine, nursing and policy development in intensive care : an ethnography to explore the contemporary nursing role". Thesis, Oxford Brookes University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.323909.
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Barlow, Hilary Joan. "An evaluation of neonatal nursing care in selected hospitals in the Western Cape". Thesis, Stellenbosch : University of Stellenbosch, 2003. http://hdl.handle.net/10019.1/16253.
Testo completoAbstract (sommario):
Thesis (MCUR)--University of Stellenbosch, 2003.ENGLISH ABSTRACT: South Africa has a proud history of a high standard of health care delivery in State funded hospitals. This implies that high standards of education and care in both medical and nursing training have been achieved. The care of sick and premature newborn infants by nurses is a speciality that has evolved worldwide over the last forty years as a result of various technological developments. In order to ensure the standard of care delivered, protocols of care should be available for nurses to refer to and to measure their work against. There were no protocols of care available in the two Neonatal Units (NICUs) used in this study. Using a non-experimental, exploratory descriptive design, the researcher set about measuring the quality of nursing care in the NICUs. Standards (structure, process and outcome) were written by the researcher, and validated. The results showed that the standards were not met at an acceptable level in various areas. One of the areas of great concern was the lack of effective hand washing. Outcome standards which reflect the consequences of care indicated serious shortages of staff in some cases and insufficient staff training. Recommendations are that a Quality Assurance Program should be introduced with training and education of the nurses working in the NICUs and the introduction of evidencebased practice. Future research should aim at showing the way to improve the service delivered.
AFRIKAANSE OPSOMMING: Suid-Afrika het ‘n trotse geskiedenis van ‘n hoë standard van gesondheidsorgdienslewering in Staatsbefondsde hospitale. Dit impliseer dat hoë standaarde in mediese en verpleegopleiding bereik is. Die versorging van siek en premature pasgebore babas deur verpleegkundiges is ‘n spesialiteit wat oor die afgelope veertig jaar wêreldwyd ontwikkel het as gevolg van verskeie tegnologiese ontwikkelings. Ten einde te verseker dat ‘n hoë standard van sorg gelewer word, moet protokolle beskikbaar wees vir verpleegkundiges om te gebruik en hulle werkverrigting teen te meet. Daar was geen protokolle beskikbaar in die twee neonatale eenhede wat in hierdie studie gebruik is nie. ‘n Nie-eksperimentele, verkennende, beskrywende ontwerp is deur die navorser gebruik om die gehalte van verpleegsorg in die neonatale eenhede te evalueer. Standaarde (struktuur, proses en uitkoms) is deur die navorser opgestel en gevalideer. Die resultate toon aan dat die standaarde in verskeie areas nie aanvaarbaar nagekom word nie. ‘n Kommerwekkende bevinding was die afwesigheid van effektiewe was van hande. Uitkomsstandaarde wat die resultaat van sorg weerspieël, het aangedui dat daar ernstige tekorte aan personeel in sommige gevalle bestaan het asook onvoldoende opleiding van personeel. Aanbevelings is dat ‘n Gehalteversekeringsprogram ingestel behoort te word en met die opleiding van verpleegkundiges werksaam in die neonatale eenhede en evidence-based practice aangespreek moet word. Toekomstige navorsing behoort aan te dui hoe om die diens wat gelewer word, te verbeter.