3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Critical care assistants opinions of the Health Professions Council of South Africa register closure and change in clinical practice guidelines(2020) Rosslee, Frauke RenateCritical Care Assistants (CCAs) have traditionally provided advanced life support care to patients in the prehospital field in South Africa. Training of CCAs came to an end in 2018 and their register was closed at the Health Professions Council of South Africa (HPCSA). At the same time, the HPCSA Professional Board for Emergency Care (PBEC) implemented Clinical Practice Guidelines (CPGs) for the emergency care profession. This resulted in a change in the scope of practice for CCAs. This qualitative study explored the opinions of CCAs on the HPCSA register closure and change in CPGs. Fourteen CCAs were interviewed from South Africa’s Gauteng Province. Data were collected through individual in-depth interviews, which were transcribed and analysed to derive themes and categories. Three themes were identified. These were education opportunities, personal impact and concern for profession. Pathways for CCAs to access Higher Education Emergency Care programmes need to be established. Communication platforms need to be developed for the effective implementation of the CPGs.Item Descriptive study of women with eclampsia requiring intensive care unit admission at Chris Hani Baragwanath academic hospital(2019)Eclampsia is a life threatening condition and the most widely recognized complication of hypertensive disorders of pregnancy requiring intensive care admissions. It is also an important cause of maternal and perinatal morbidity and mortality, and accounts for approximately 63000 maternal deaths every year globally. Objectives To determine the incidence, outcomes and complications of women with eclampsia admitted to the intensive care unit at Chris Hani Baragwanath Academic Hospital (CHBAH). Methods A retrospective cross sectional study of all women with eclampsia admitted to the intensive care unit at CHBAH. Results There were 57 women with eclampsia admitted to ICU between January 2011 and December 2016. Eclampsia with ICU admissions was most common between the ages of 16-20 years (n=18, 31.5%) and more prevalent in primigravida. The incidence rate of ICU admission in women with eclampsia is 44/100 000 births per year. There were three maternal deaths from eclampsia. Maternal and fetal complications that developed in ICU were HELLP syndrome (n=15, 26.3%), acute renal failure (n=11, 19.2%), metabolic acidosis (n=9, 15.8%), pulmonary oedema (n=8, 14%), preterm births (n=31, 52.5%), birth asphyxia (52.5%) and low birth weight (45.8%). The reason for ICU admission was haemodynamic monitoring (100%), ventilation (89%), cardiopulmonary resuscitation (45%), renal support (19%) and inotropes (16%). Conclusion Eclampsia is a preventable condition affecting women mostly in low to middle income countries. Eclampsia that requires ICU admission is often associated with life-threatening multi-organ system maternal and fetal complications. Measures to prevent eclampsia need to be strengthened.Item Bridging the gap : establishing the need for a dysphagia training programme for nurses and speech-language therapists working with tracheostomised patients in critical care in government hospitals in Gauteng.(2012-08-28) Hoosen, AzraThe primary objective of the current study was to attempt to establish whether there is a need for a dysphagia training programme for nurses and speech-language therapists working with acute tracheostomised patients in critical care units in South Africa. The research design that was adopted for this project was within a mixed methods approach framework. An exploratory descriptive survey design using semi-structured face-to-face interviews was used. The final sample consisted of interviews with 20 speech-language therapists from eight different hospitals with critical care facilities and 12 nurses from four different hospitals with such facilities. Data from the close ended questions were analysed using descriptive statistics, while remaining data from open ended questions were thematically analysed and the constant comparison method was applied. The data demonstrated that all speech-language therapists and 10 out of the 12 nurses were in agreement that there was a need for a dysphagia training programme for nurses in critical care for tracheostomised patients presenting with dysphagia. An important and unexpected result of this study was that speech-language therapists themselves required additional training in this area. The data demonstrated that the majority of speech-language therapists and nurses were of the view that they had received minimal theoretical and practical hours on tracheostomy screening, assessment and management at an undergraduate level. Overall, the results of the current study suggested varied practices in the screening, assessment and management of tracheostomy and dysphagia, particularly with regard to blue dye testing, suctioning protocols and cuff inflation and deflation protocols. The research significance and implications of the study included the need to improve undergraduate training for speech-language therapists and nurses in the area of dysphagia and tracheostomy, to alert professional training bodies regarding institution of additional licensing and qualifications for speech-language therapists and nurses in the area of dysphagia and tracheostomy, and to thereby improve the situation of clinicians practising in dysphagia and tracheostomy management through the development of guidelines, protocols and position papers. An important implication of this research is that it established the need for a dysphagia training programme for both speech-language therapists and nurses in critical care in dysphagia and tracheostomy, and thereby monitoring the efficacy of this programme and measuring/monitoring the outcomes of multidisciplinary teamwork in the assessment and management of dysphagia and tracheostomy in critical care.