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 Optimising nursing handover in the intensive care unit by managing distracters(2018) Van der Merwe, Chalet AletBackground: Distracters in any form will cause a break in the train of thought diverting nurses’ attention away from the handover and vital information regarding the patients care may be lost. It prolongs the handover time and delays treatment in the already vulnerable critically ill patient. Identification of the type and frequency of distracters are therefore vital. It does not only create a bigger awareness among nursing staff, but enables them to come up with new ideas and strategies on limiting the amount of distracters that places patients and the continuity of safe patient care at risk. Objective: The purpose of the study was to optimise the nursing handover in the intensive care unit (ICU) by identifying and managing distracters which may interfere with the handover process. It aimed to implement and manage new handover strategies in an attempt to reduce the type and frequency of distracters during bedside handover in the Intensive Care Units (ICUs). This could optimise the handover practice, thus enabling nurses to deliver safe patient handover from one shift to another and reduce the amount of distracters during handovers. Method: A mixed method design was used. Observational, descriptive and participatory phases were included. The study followed three sequential phases. Use was made of a before and after study intervention model. Observed data was gathered by means of a structured observation checklist during phase one. Phase two a qualitative phase followed phase one. Qualitative data was collected through collaboration with a focus group of experts. Categories that emerged from phase one, were presented to the focus group. Experts in this focus group collaborated on the findings /categories and developed ideas on strategies they thought they would be able to implement and manage in their units to limit the amount of distracters during the handover period. Phase three, the final phase followed the same structured observation as phase one once the new handover strategies had been implemented for a period of two months. Setting: The study was conducted in the Intensive Care Units (ICUs) of five hospitals in the private sector. Four hospitals are situated in Gauteng and one hospital is situated in Mpumalanga. This included 94 ICU beds with an average of 90% occupancy over the last three months. Both day and night shift handovers were included in the study. Results: Four main distracters were identified. Results from phase one showed that during observation of the handovers a large number of distracters 76 occurred. Social conversation among nurses interrupting the handover was the most common distracter (48.7%) followed by monitor alarms, IV alarms and Doctors rounds. A great amount of time was being spent on distracters during the handover period in the various ICU areas. The overall mean value for time spent on distracters was (M=82.3) seconds during phase one. Phase two a qualitative phase included a group of experts with qualifications in critical care nursing science. The distracters identified in phase one were put forward for discussion to the group of experts in phase two. The experts from phase two collaborated on strategies and collectively came to an agreement on the type of strategies they thought they would be able to implement in their units to enable them to limit the amount of distracters. The strategies agreed upon were implemented over a period of two months, where after the researcher returned to re-evaluate whether strategies implemented brought about a change in limiting the amount of distracters during the handover period. A total of 76 handovers were observed in phase three after the new handover strategies had been implemented. The same four distracters from phase one were once again identified as the main distracters during the handover period. This occurred in spite of implementation of the new handover strategies. There was however a significant decrease in the incidence of these distracters. Conclusion: Distracters are unavoidable in the ICU environment. Nurses should become more aware of their role in limiting distracters during the handover period. Knowledge sharing among nurses can close this gap in the development of appropriate strategies in order to limit distracters that would compromise the continuity of safe patient care. It is hoped that findings from this study could be used by others in the development of strategies in limiting the amount of distracters during the handover period, thereby improving patient safety. Keywords: Distracters, frequency, handover, patient safety